Instrumentation For Knee Resection

ABSTRACT

A system for performing a resection of a selected portion of an anatomy with a resection instrument. The system includes a first member, a first movement defining portion defined by the first member, a second member, and a second movement defining portion of the second member. The first member is fixable to the selected portion of the anatomy. The second member is configured to cooperate with the first member. The first movement defining portion and the second movement defining portion are operable to allow the second member to be moveable relative to the first member from a first position to a second position. The resection instrument is positionable relative to the second member in the first position and in the second position to form a selected resection of the selected portion of the anatomy.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation patent application of U.S. patentapplication Ser. No. 14/047,361 filed on Oct. 7, 2013, which isscheduled to issue as U.S. Pat. No. 9,023,053 on May 5, 2015 and is adivisional patent application of U.S. patent application Ser. No.11/337,861 filed on Jan. 23, 2006, which issued as U.S. Pat. No.8,551,100 on Oct. 8, 2013 and is a continuation-in-part of U.S. patentapplication Ser. No. 11/058,527 filed on Feb. 15, 2005, which issued asU.S. Pat. No. 7,789,885 on Sep. 7, 2010 and is a continuation-in-part ofU.S. patent application Ser. No. 10/931,220 filed on Aug. 31, 2004,which issued as U.S. Pat. No. 7,887,542 on Feb. 15, 2011 and is acontinuation-in-part of U.S. patent application Ser. No. 10/345,102filed on Jan. 15, 2003, which issued as U.S. Pat. No. 7,837,690 on Nov.23, 2010. The disclosures of the above applications are incorporatedherein by reference.

FIELD

The present teachings relate to orthopedic surgery, and particularly to,knee resection procedures and instruments.

INTRODUCTION

The human anatomy includes many articulating portions. For example, thefemur and the tibia form a knee joint in the human anatomy. The femurand tibia articulate relative to one another during many activities,such as walking or kneeling. Nevertheless, over time, disease and/orinjury can deteriorate the knee joint, such that articulation of thejoint becomes painful or impractical. When such injuries occur,anatomical replacements, particularly prosthetics, can be placed in thefemur, tibia, or both. The prosthetics may replace the articulatingportions and allow a substantially natural articulation of the joint.Replacing the damaged portions allow for a much easier and morepractical articulation of the knee joint to assist the individual inreturning to a more natural lifestyle.

To replace joints, such as the knee joint, the original or naturalanatomy, including boney portions, must first be removed or resected.For example, the knee joint includes the condyles of the femur and thetibial plateau. The condyles of the femur articulate with a meniscus inthe knee joint, which is supported by the tibia. To replace the kneejoint, particularly replacing the articulating portions, the tibialplateau and the condyles of the femur are generally removed.

Often, the condyles of the femur are removed with a saw blade or otherreaming devices. The femur is shaped to receive the prosthetic, whichwill simulate the condyles of the femur after implantation.Specifically, the femur must be shaped to substantially compliment thesuperior portion of the femoral implant to ensure a substantially tightand secure fit between the femoral implant and the femur.

Likewise, the tibia must be resected to properly receive the tibialimplant. This often requires removing the superior portion of the tibiaso that an implant can be securely fixed to the superior portion of theresected tibia. A saw blade or other reaming device is used to removethe superior portion and substantially flatten the superior portion ofthe tibia. After this, a tibial implant can be implanted onto the tibiaand securely fixed in place.

To perform such knee replacements, and other joint replacements, it maybe desirable to allow a less invasive procedure. During less invasivesurgeries, the incision to insert the tools may be kept to a minimum,should a surgeon desire. Likewise, the tools and instruments used toperform the procedure are optimized to provide minimal abrasion andtrauma to the surrounding soft tissue. Therefore, it may be desirable toprovide instruments that can be used through very small incisions todecrease the amount of trauma to the soft tissue. Similarly, the ease ofuse of the smaller instruments may be desired to be enhanced to allowfor an efficient and proper use during the surgical procedure.

In total knee joint replacement procedures, the proximal end of thetibia is generally resected at a desired angle to define a tibialresection plateau for receiving a tibial implant. Devices for performingthe tibial resection generally include a cutting block which guides asaw blade.

SUMMARY

Devices and methods that may be used during a minimally invasive surgeryfor a joint resection include a saw blade and cutting block. The sawblade that may be used use in a minimally invasive surgery includes anarrowed neck or body to allow for an ease of use through a smallincision. The head, which include cutting teeth, can be broader than theneck of the saw blade. The narrowed neck allows the blade to translatein a small incision, without abrading the soft tissue. A second sawblade may include an angled neck. The angled neck may also be narrowedrelative to the cutting head, but the angled neck allows the cuttinghead to be laterally offset from the power tool. Therefore, all portionsof a joint, such as the knee joint, can be reached from a singleincision, which is placed medially or laterally on the knee. Inconjunction with the above-described saw blades and other generallyknown saw blades, a cutting block, which is able to translate mediallyand laterally is also described. Specifically, a cutting block can bemounted to the inferior portion of the femur and used as a cutting guideduring the resection procedure. The cutting block may be movedmedially/laterally, along with the incision and soft tissue, such thatthe cutting guide or cutting block need not be repositioned other thanbeing slid along a rail.

According to various embodiments a guide block assembly for assisting inresecting a boney structure is disclosed. The assembly comprises a trackmember having a fixation section to fix the track member to the boneystructure and a track translation section. The assembly also includes acutting block having a guiding section adapted to guide a cutting memberand a guide translation section to operably engage the track translationsection. The track translation section and the guide translation sectionoperably interact to allow the cutting block to translate relative tothe track member. This allows the cutting block to be selectivelypositionable in more than one position while the track member remains ina single position.

According to various embodiments a saw blade for resecting a portion ofan anatomy is disclosed. The saw blade comprises a first end having atool engaging section extending along a first longitudinal axis. The sawblade further comprises a second end having a cutting head defining aplurality of cutting teeth, and extending along a second longitudinalaxis. A neck portion interconnects the cutting head and the toolengaging section. The first and second longitudinal axes intersecting atthe neck portion. The first axis and the second axis are disposed suchthat the cutting head is laterally offset from the tool engagingsection.

According to various embodiments a kit for resecting a portion of ananatomy is disclosed. The kit comprises at least one saw blade includinga cutting head and a neck portion and a guide block assembly including atrack member and a cutting block. The track member includes a fixationsection to fix the track member to a structure and a track translationsection. The cutting block includes a guiding section adapted to guide amember and a guide translation section to operably engage the tracktranslation section. The track translation section and the guidetranslation section operably engage to allow the cutting block totranslate relative to the track member.

According to various embodiments a method for resecting a boney portionof an anatomy that is surrounded by soft tissue is disclosed. The methodcomprises creating an incision in the soft tissue surrounding the boneyportion. A saw blade is selected to resect a first portion of the boneyportion. A guide rail is mounted in a first rail position relative theboney portion. A cutting block is positioned in a first cutting blockposition relative to the guide rail to guide the saw blade. The cuttingblock is moved to a second cutting block position relative to the guiderail, such that the cutting block guides the saw blade in the secondcutting guide position while the guide rail remains in the first railposition.

According to various embodiment an instrument for guiding a toolrelative to a portion of an anatomy is disclosed. The instrumentationmay include a track member and a translating member associated with thetrack member to translate relative to the track member. Also, apositioning member may be provided that is operable to associate atleast one of the track member or the translating member relative to theanatomy. The track member is operable to be fixed to the anatomy in anassociated position.

According to various embodiments instrumentation for guiding a toolrelative to a selected portion of an anatomy is disclosed. Theinstrumentation may include a track member operable to be fixed to theanatomy having a first length between a first end and a second end and aguide member including a second length between a first guide end and asecond guide end. A guide surface may be defined by at least a portionof the guide member. The first length and the second length are lessthan a dimension of the anatomy to be affected by the tool.

According to various embodiments a method of guiding a tool relative toa portion of an anatomy with a moving guide member is disclosed. Themethod may include positioning a track member relative to the anatomyand positioning the guide member relative to the anatomy with the trackmember in a first position. A tool may be guided relative to the anatomywith the guide member in the first position and the guide member may bemoved to a second position. The tool my also be guided relative to theanatomy in the second position.

The present teachings may also provide an apparatus for performing atibial resection in a minimally or less invasive resection procedure orin a conventional open procedure. The methods and apparatuses of thepresent teachings may allow for a resection to occur through a smallincision and generally minimally invasively. For example, the apparatusmay be positioned for resecting a tibia through a generally smallincision and with minimal impact on associated soft tissue. Theapparatus includes a support block attachable to a tibia or otherappropriate portion, a cutting guide defining a saw blade or guide slot,and an engagement device coupling the cutting guide to the support blocksuch that the cutting guide can move relative to the support block suchas by rotating and/or along an angled arcuate path.

The present teachings also provide a modular sizing device for a bone.The sizing device includes a sizer base positionable relative to thebone, a stylus, and a coupler operable to magnetically couple the baseto the stylus for measuring a size of the bone.

The present teachings further provide a modular cutting device for abone. The cutting device includes a cutting block having a cutting slot,an alignment guide removably couplable to the cutting block, and a drillguide slidably couplable to the cutting block.

The present teachings further provide a kit of surgical components forfemoral sizing. The kit includes a stylus, a sizer base including anextension for receiving a fastener, a coupler for coupling the sizerbase to the stylus, a magnet receivable in a cavity of the coupler formagnetic attachment to the stylus, and a spring-loaded handle forengaging the fastener.

The present teachings may also provide a tibial resection apparatus thatincludes a support block attachable to tibia and a cutting guidedefining a saw blade slot. The support block has a superior surfacedefining an angled arcuate groove, and the cutting guide has a pegreceivable in the arcuate groove, such that the cutting guide can slidealong the groove and rotate about the peg relative to the support block.

The present teachings provide for a system for performing a resection ofa selected portion of an anatomy with a resection instrument. The systemincludes a first member, a first movement defining portion defined bythe first member, a second member, and a second movement definingportion of the second member. The first member is fixable to theselected portion of the anatomy. The second member is configured tocooperate with the first member. The first movement defining portion andthe second movement defining portion are operable to allow the secondmember to be moveable relative to the first member from a first positionto a second position. The resection instrument is positionable relativeto the second member in the first position and in the second position toform a selected resection of the selected portion of the anatomy.

The present teachings further provide for a system for resecting aproximal tibial portion with a resection instrument. The system includesa main guide portion, a first dynamic connection portion included withthe main guide portion, a dynamic guide member, a guide surface, and asecond dynamic connection portion. The guide surface is defined by thedynamic guide member and is configured to guide the resection instrumentduring resection of the proximal tibial portion. The second dynamicconnection portion is included with the dynamic guide member. The firstand the second dynamic connection portions are configured to cooperatewith one another to guide movement of the dynamic guide member and theguide surface.

The present teachings also provide for a method for resecting a proximalportion of a tibia. The method includes fixing a main guide portionincluding a first dynamic connection portion to the tibia; coupling adynamic guide member to the main guide portion through cooperationbetween the first dynamic connection portion and a second dynamicconnection portion of the dynamic guide member; guiding a resectioninstrument to the tibia with a guide surface of the dynamic guidemember; and sliding and rotating the dynamic guide member to guide theresection instrument to various portions of the tibia.

Further areas of applicability will become apparent from the detaileddescription provided hereinafter. It should be understood that thedetailed description and specific examples, while indicating variousembodiment of the invention, are intended for purposes of illustrationonly and are not intended to limit the scope of the following claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The present description will become more fully understood from thedetailed description and the accompanying drawings, wherein:

FIG. 1 is an anterior view of a right knee of a human anatomy;

FIG. 2 is a plan view of a narrow saw blade according to one embodiment;

FIG. 3 is a perspective view of the saw blade in conjunction with aguide or cutting block;

FIG. 4 is a cross-sectional view of the saw blade taken along line 4-4;

FIG. 5 is an elevational view of a portion of a tibia and an angled sawblade according to a second embodiment;

FIG. 6 is a plan view of an offset saw blade according to an embodiment;

FIG. 7A is a perspective view of a cutting block assembly with a sawblade disposed therethrough;

FIG. 7B is a cross-section taken along the line B-B of FIG. 7A;

FIG. 8 is a cross-sectional view of a rail assembly according to analternative embodiment;

FIG. 9 is a perspective view of a cutting block and rail assemblyaccording to an alternative embodiment;

FIG. 10A is a side elevational view of a femur including the cuttingblock assembly, according to an embodiment, attached thereto;

FIG. 10B is a perspective view of a knee joint illustrating an exemplaryuse of the cutting block and saw blade;

FIG. 10C is a cross-sectional view of the cutting block assembly affixedto a distal end of a femur;

FIG. 11 is a perspective view of a moveable guide block;

FIG. 12 is a perspective view of a movable guide block assembly;

FIG. 13 is a partial cross-sectional view at a knee including a movableguide assembly;

FIG. 14 is a perspective environmental view of a movable cut guide inuse;

FIG. 15 is an isometric view of a tibial resection apparatus accordingto the present teachings;

FIG. 16A is an isometric view of an exemplary support block for thetibial resection apparatus of FIG. 15;

FIG. 16B is an isometric view of an exemplary support block for a tibialresection apparatus according to the present teachings;

FIG. 17A is a top view of an exemplary cutting guide for the tibialresection apparatus of FIG. 15;

FIG. 17B is a top view of an exemplary cutting guide for coupling to thesupport block FIG. 16B;

FIG. 18 is a front view of the cutting guide of FIG. 17A;

FIG. 19 is a side view of the cutting guide of FIG. 17A;

FIG. 20 is an isometric view of a support block of FIG. 15, shown astylus;

FIG. 21A is an environmental plan view of a tibial resection apparatusaccording to the present teachings in a first position on a right leg;

FIG. 21B is an environmental plan view of a tibial resection guideaccording to the present teachings in a second position on a right leg;

FIG. 22 is an environmental side view of a tibial resection apparatus ofFIG. 21 on a right leg;

FIG. 23 is an environmental isometric view of a support block and tibialguide attached to the tibia according to the present teachings; and

FIG. 24 is an isometric view of a support block attached to an alignmenthandle according to the present teachings; and

FIG. 25A is a plan view of a rotating guide according to variousembodiments;

FIG. 25B is a perspective view of the guide of FIG. 25A;

FIG. 26 is an exploded perspective view of a moveable resection guideaccording to various embodiments;

FIG. 27 is a detail environmental view of the moveable resection guideof FIG. 26;

FIG. 28 is a perspective view of a moveable resection guide according tovarious embodiments;

FIG. 29 is a perspective view of a kit including various saw blades andcutting block assemblies;

FIG. 30 is a perspective view of a modular sizing device according tothe present teachings;

FIG. 31 is a perspective view of the sizing device of FIG. 30, shownwithout a stylus;

FIG. 31A is a perspective view of a modular sizing device according tothe present teachings;

FIG. 32 is an environmental perspective view of a modular cutting deviceaccording to the present teachings;

FIG. 33 is a perspective view of the cutting device of FIG. 32, shownwithout an alignment guide;

FIG. 34 is a perspective view of an alignment guide for the cuttingdevice of FIG. 32;

FIG. 35 illustrates a kit of surgical components according to thepresent teachings;

FIG. 36 is an environmental view of the sizing device of FIG. 30, shownduring a surgical procedure;

FIG. 37 is a perspective view of soft tissue retractor according to thepresent teachings shown coupled with a cutting guide;

FIG. 38 is a front plan view of a guide apparatus;

FIG. 39 is a front exploded perspective view of a guide apparatusaccording to various embodiments;

FIG. 40 is a back perspective exploded view of a guide apparatusaccording to various embodiments;

FIG. 41 is an environmental view of a guide apparatus in use; and

FIG. 42 is a plan illustration of a kit including a guide apparatusaccording to various embodiments.

DETAILED DESCRIPTION OF VARIOUS EMBODIMENTS

The following description of various embodiments is merely exemplary innature and is in no way intended to limit the appended claims, itsapplication, or uses. Although the following various embodiments areillustrated in use with a knee joint and/or minimally invasive surgery,it will be understood that the apparatuses and methods described hereincan be used in conjunction with any other joint on any surgicalprocedure. For example, the saw blades and the cutting block may be usedto resect the shoulder, elbow, or other joints in the anatomy.Therefore, the following description relating to a knee joint is merelyexemplary and not intended to limit the scope of the following claims.

With reference to FIG. 1, a knee joint 10 (illustrated as a right leg)of a human anatomy includes a femur 12 that can articulate with a tibia14. The tibia 14 of the right leg includes a medial side 14 a and alateral side 14 b. Disposed between the femur 12 and the tibia 14 is ameniscus 16, which cushions the articulation and provides a bearingbetween the two boney portions or structures. The knee joint 10 furtherincludes a fibula 18 and a patella 20. Surrounding the knee joint 10 isa soft tissue 22, which includes muscle, adipose tissue, and theepidermis. To perform any procedures on the internal components of theknee joint 10, the soft tissue 22 must be pierced. The femur 12 includesa first condyle 26 and a second condyle 28. It will be understood thatthe first condyle 26 may be a lateral condyle when the knee is a rightknee, such as the knee illustrated in FIG. 1. It will be understood thatthe following discussion and instruments may also applicable, with minorchanges, if any, to a left knee as well.

The knee joint 10 may become damaged or injured such that smallfractures 24 or other injuries or deteriorations occur. When suchinjuries become great enough, the knee joint 10 may be resected and aprosthetic implanted to replace the articulating portions. The first andsecond condyles 26, 28 define an inferior surface of the femur 12.Moreover, the femur 12 is generally rounded and includes arcs androunded surfaces of the first and second condyles 26, 28 on the inferiorside of the femur 12. These convex surfaces provide for easyarticulation of the femur 12 with the tibia 14. Similarly, convexsurfaces are defined by the femur 12 on the anterior 12 b and posterior12 c (shown in FIG. 10B) sides as well. However, to implant aprosthetic, it is generally easier and more efficient to mount theprosthetic to substantially planar surfaces. Therefore, the convexsurfaces of the femur 12 are resected before implanting a prosthetic. Toprovide such a resection, an incision 30 is made through the soft tissue22 to gain access to the knee joint 10 (in FIG. 10B). Though variousstyles and methods of making the incision 30 are known, however asurgeon may find it desirable to provide a less invasive incision 30.Therefore, the incision 30 is generally between about 1 cm and about 10cm in length to provide access to the knee.

Because the incision 30 is made through the soft tissue 22, the incision30 may be a small size and moved relative to the femur 12 and the tibia14 to perform the procedure. Nevertheless, the smaller incision 30, theless trauma provided to the soft tissue 22. Because of the smallincision 30, the instruments provided to resect the knee joint 10 aredesigned to efficiently perform their tasks without further traumatizingthe soft tissue 22 and able to fit through the incision 30.

With reference to FIG. 2, a saw blade 100 for resecting a portion of theknee joint 10 is illustrated. The saw blade 100 may be used to resectthe inferior portion of the femur 12, including the first and secondcondyles 26, 28 or the superior portion of the tibia 14. The saw blade100 includes a tool engaging end or section 102, a body or neck 104, anda cutting head 106. The tool engaging end 102 includes a tool receivingnotch 108, which is defined by a first leg 110 and a second leg 112. Inthis way, a portion of a power tool (not illustrated, but generallyknown) can be received within the tool receiving notch 108 to operatethe saw 100 within the knee joint 10. It will be understood that anyappropriate means or design may be used to affix the saw blade 100 toany appropriate tool. The tool engaging notch 108 is simply exemplary ofany numerous method, which may be used to properly affix the saw blade100 to a power tool. Other exemplary methods include a compression fitwith a set screw or a bore formed in the saw blade 100, which wouldreceive a set screw, but not include a notch. Therefore, theillustration of the exemplary tool engaging notch 108 is not intended tolimit the present disclosure or the following claims. Furthermore, thetool engaging end 102 may be any appropriate size, including anyappropriate width or depth to be properly received within a power tool.For example, the power tool may require that the tool engaging end 102of the saw blade 100 be at least 1.5 cm in width. Therefore, the toolengaging end 102 may be at least 1.5 cm in width.

The neck 104 of the saw blade 100 has a width A which is selected to benarrower than a width B of the cutting head 106. Although width A of thesaw blade 100 can be any appropriate width, it is generally selected tobe relatively small to lessen abrasion and trauma to the soft tissue 22defining the incision 30. This design also increases utility of acutting guide as described more fully herein.

With continuing reference to FIG. 2 and additional reference to FIG. 3,the width A of the neck 104 also allows a greater area to be resected bythe saw blade 100. Specifically, as illustrated in FIG. 3, the narrowwidth A of the neck 104 allows the cutting head 106 to resect an areawhich is beyond the width of a cutting block 120. Because of the narrowwidth A of the neck 104, the cutting head 106 is able to easily resectan area at least a distance X beyond the edge of the slot 121 defined bythe cutting block 120. The slot 121 defines a guide area of the cuttingblock 120. A saw blade including a neck and cutting head of equal widthslimits the amount of area that a user is able to resect outside of thewidth of the slot 121. The narrow neck 104, however, allows the distanceX to be resected outside of the width of the slot 121. The saw blade 100is able to resect the distance X on both sides of the cutting block 120during use.

Even though the neck 104 may have a selected width A, the cutting head106 may have a different selected width B. Defined on the distal end ofthe saw blade 100 are cutting teeth 114. The cutting teeth 114 move inconjunction with the cutting head 106 and provide a sawing action to sawand remove material that is to be resected. The cutting teeth 114 may beany appropriate design or shape to provide the desired resection, speedor efficiency. Nevertheless, the width B of the cutting head 106 may beselected to allow for a greater cutting width than the width of the neckA. Although, the width A of the neck 104 may be selected to be smallerthan the width of the retracted incision 30, the width B of the cuttinghead 106 may be selected to be greater than the width of the incision30. For example, the width B of the cutting head 106 may be at leasttwice as big of the width A of the neck 104. This provides a cuttingarea, which is greater than the width of the neck 104, while minimizingtrauma to the soft tissue 22.

With continuing reference to FIG. 2, and additional reference to FIG. 4,the neck 104 of the saw blade 100 includes a first side 104 a and asecond side 104 b. The edges or sides 104 a and 104 b of the neck 104may include convex or other smooth non-angular shapes. The smooth andnon-angular shapes further minimize trauma to the soft tissue 22 duringoperation. Simply, the saw 100 vibrates back and forth to move thecutting teeth 114. Even though the width A of the neck 104 is less thanthe width of the retracted incision 30, the edges 104 a and 104 b of theneck 104 may still contact the soft tissue 22. Therefore, removing theharsh or angular edges of the neck 104 help minimize trauma, to the softtissue 22.

With reference to FIG. 5, an angled saw blade 130 including a toolengaging end 132, a neck 134, and cutting head 136 is illustrated. Thesaw blade 130 may be used in conjunction with a cutting block(illustrated herein), which is mounted relative the tibia 14 for theprocedure. An incision is made in the soft tissue 22 to allow access ofthe saw 130 to the tibia 14. The tool engaging end 132 may include apower tool engaging notch 140, such that a power tool may operate thesaw blade 130. In addition, the cutting head 136 defines a plurality ofcutting teeth 142. Similar to the saw blade 100, the neck 134 of the sawblade 130 may have a width, which is less than the width of the cuttinghead 136. In addition, the width of the neck 134 may be less than thewidth of the incision 30 made in the soft tissue 22.

The tool engaging end 132 defines a first longitudinal axis D. Inaddition, the neck 134 defines a second longitudinal axis E. The firstlongitudinal axis D of the tool engaging body 132 is angled relative tothe second longitudinal axis E of the neck 134. The angle F between thetwo axes may be any appropriate angle. For example, the angle F may bean obtuse angle to provide access to both sides of the tibia 14. Theangle F allows an incision 30 to be placed on a selected side of thetibia 14 through the soft tissue 22. For example, if the tibia 14 is theright tibia, the incision may be formed medially relative to the tibia14 (as in FIG. 1). If the saw blade 100 were only used, it would bedifficult to resect the lateral side 14 a of the tibia 14. The saw blade100 would need to be moved relative to the tibia 14 to reach the lateralside 14 a. This may cause trauma to the soft tissue 22 by moving the sawblade 100 or a cutting block. Especially if a cutting block were fixedrelative the tibia 14, it would be very difficult and require additionaltime to move a cutting block relative the tibia 14. With the use of theangled saw blade 130, the lateral side 14 a of the tibia 14 can beeasily reached with the cutting teeth 142.

The angle F allows the cutting head 136 to be positioned in a space notaligned with the first longitudinal axis C of the tool engaging end 132.This allows the cutting teeth 142 to cut an area of the tibia 14, whichis not aligned with the axis D. It will be understood that the angledsaw blade 130 may also be angled in the opposite direction. This willallow for the angled saw blade 130 to enter the knee area on the lateralside and reach to the medial side of the tibia 14. Regardless of thesize of the angle F or the direction of the angle F, the angled sawblade 130 allows the cutting teeth 142 to cut an area that is notaligned with the longitudinal axis of the tool engaging body 132.

With reference to FIG. 6, an alternative angled saw blade or offset sawblade 150 is illustrated. The offset saw blade 150 includes a toolengaging section 151, a cutting head 152, and a neck portion 153. Theneck portion 153 includes a first angle or bend 154 and a second angleor bend 155. This allows the cutting head 152 to be laterally offsetfrom the tool engaging section 151 without being angled thereto. Morespecifically, the tool engaging section 151 extends along a first ortool engaging section axis G while the cutting head 152 extends along asecond or cutting head longitudinal axis H. The first axis G islaterally offset from the second axis H, but is parallel thereto.Therefore, the offset saw blade 150 can resect a portion of anatomy notin line with the cutting section 151 yet parallel therewith. The angledsections 154 and 155 may also be referred to or illustrated as “steps”of the neck portion 153.

With reference to FIGS. 7 a and 7 b, a sliding or translating cuttingblock assembly 160 is illustrated. The translating cutting block system160 includes a cutting block 162, which is able to translate or slide ona rail or track member 164. The cutting block 162 includes a post orwall 166 a and 166 b, which is adapted to push the soft tissue 22 awayfrom a saw blade bore 168 during use, as described further herein.Formed through the cutting block 162 is the saw blade bore 168. Althoughthe cutting block 162 is illustrated to define a saw blade bore or slot168, which acts as a saw blade guide, as described further herein, a sawblade bore 168 is not required for a cutting block 162. Specifically,the cutting block 162 may also only define surfaces which are used ascutting guides. Therefore, rather than placing the saw blade 100 througha slot formed in the cutting block 162, the saw blade 100 would onlyride or translate along a surface of the cutting block 162 to direct thesaw blade during use. Therefore, it will be understood that a saw bladebore 168 may define a guiding section or a surface of the cutting block162 alone may define a guiding section.

Cutting blocks for resection, similar to the cutting block 162 aregenerally known, such as the 4-IN-1 CUTTING BLOCK, supplied by Biomet,Inc. of Warsaw, Ind. The cutting block 162 guides the saw blade 100 or132 during a resection procedure to ensure that the proper areas of theboney portions are cut during the resection. However, the cutting block162 is able to translate medially/laterally, by riding on the rail 164.

Specifically, the cutting block 162 includes a rail engaging section170, which may define a female dove tail. Likewise, the rail 164includes a rail translation section 172, such as a complimentary maledove tail. The rail engaging section 170 operably engages the railtranslation section 172 so that the cutting block 162 is not able tosubstantially distract from the rail 164. Nevertheless, the cuttingblock 162 is able to move medial/laterally in the direction of arrow Gby moving along the rail 164. It will be understood that the railtranslation section 172 may define any portion complimentary to theguide or cutting block translation portion 170 to allow the cuttingblock 162 to translate relative the rail 164. For example, the railtranslation section 172 may define a “T” shaped projection or a recess.Therefore, the guide translation portion 170 would be complimentarilyshaped to engage the rail translation portion 172 for translation of thecutting block 162.

Although the cutting block 162 may be translated along the rail 164, thecutting block 162 may also be selectively locked relative the rail 164,if desired. The cutting block 162 may include a locking pin 174, whichcan be depressed to engage notches 176 formed in the rail 164. Thelocking pin 174 may be engaged or unengaged in any position, which canbe selected by a user by depressing the locking pin 174. This allows thecutting block 162 to be moved to a selected position relative the rail164 and locked in place while the saw blade 100 is used. It will beunderstood that alternative means of locking the cutting block 162 in aselected position can also be used. For example, a set screw can be setagainst any position on the rail 164 to lock the cutting block 162 in aselected position. This allows for a substantially infinite selection bya user. Alternatively, no locking portion may be provided, such that thecutting block 162 is always free to move, depending upon the selectionsof the user.

With reference to FIG. 8, an alternative rail or track member 164′ isillustrated. The rail member 164′ similarly includes the bone anchorportion 180. The rail member 164′, however, includes a track translationreceiving area 182. The rail member 164′ may also include an engagingsection 184. The track translation section 172′ defines a complimentaryengaging section 186 to engage the rail member 164′. In addition, a pin188 may extend from the track translation section 172′ to engage thetrack translation receiving portion 184. In this embodiment, the railmember 164′ engages a separate track translation section 172′.Therefore, a plurality of track translation sections 172′ may beprovided with the track member 164′ and a selection may be made by auser.

With reference to FIG. 9, a second alternative rail 190 is illustrated.The rail 190 includes a rail translation section 192 which is shorterthan the length of the cutting block 162. The cutting block 162 definesa cutting block translation section 194 which is longer than the railtranslation section 192. In this embodiment, movement of the cuttingblock 192 is allowed because the block translation section 194 is longerthan the rail translation section 192. In this manner, the rail 190 neednot be longer than the cutting block 162 to allow the cutting block 162to translate relative the rail 190.

As illustrated in FIG. 10, the rail 164 is mounted to a selected area ofthe boney portion, such as a distal side 12 a of the femur 12 or aportion of the tibia 14 using at least one of a plurality of mountingposts 180. The mounting posts 180 are fit into predrilled holes or boresformed into the femur 12. Specifically, the rail 164 is mounted directlyto the femur 12. Therefore, the cutting block assembly 160 is mounted toa boney structure inside the soft tissue 22. Screws may also be used totighten the posts 180 in place by providing a bore through the post 180.Alternatively, semi-permanent cements or adhesives may be used to fixthe posts 180 in place. Other methods may also be used to fix the track164 in place such as self-driving and tapping screws may be passedthrough bores formed in the rail 164 to mount the rail 164 in a selectedposition. It will be understood that any appropriate method may be usedto fix the rail 164 to a selected position. Regardless, the rail 164allows the cutting block 162 to translate to a selected position.

The interaction of the track translation section 172 and the guidetranslation portion 170 may be substituted with any other properengagement. For example, the rail 164 may define a male “T”cross-section, which is engaged by a female “T” cross-section formed onthe cutting block 162. Any appropriate engagement between the rail 164and the cutting block 162 may be provided, as long as the cutting block162 is able to translate relative the rail 164, yet not substantiallydistract from the rail 164 during or after the translation. It will beunderstood, however, that the cutting block 162 may distract from therail 164 if selected. For example, the cutting block 162 may translaterelative the rail 164 by distracting the cutting block 162 from the rail164 and moving the cutting block 162 relative thereto. Moreover, if thecutting block 162 is not locked relative the rail 164, it may beselected that the cutting block 162 distracts from the rail 164 to allowfor greater freedom of movement of a user of the cutting block 162.

With continuing reference to FIGS. 7A-10C, a method of using thetranslating cutting block 160 and the saw blade 100 is illustrated. Ifit is selected that the knee 10 requires a resection, the incision 30 ismade near the knee 10 to allow access to the knee 10 by the variousinstruments. Once the incision 30 is made, the distal or inferior end 12a of the femur 12 is first resected to form a substantially flat andplanar region.

To form the substantially planar resection of the distal end 12 a of thefemur 12, with particular reference to FIG. 10A, the cutting blockassembly 160 is fixed to an anterior side 12 b of the femur 12. The sawblade 100 is then guided with the cutting block 162 through the incision30 to form the distal cut on the distal end 12 a of the femur 12. Theinteraction of the cutting block 162 and the rail 164 allows the cuttingblock 162 to be translated medial laterally relative to the femur 12.Moreover, as described above and further herein, because the cuttingblock 162 is able to translate relative the rail 164, the cutting block162 can be minimized in size. That is, the cutting block 162 need not bethe width of the femur 12 required to be resected because the cuttingblock 162 is able to move medial laterally relative the femur 12. Thisresection substantially removes the condyles 26 and 28 and forms asubstantially flat area to form the first resection portion of the knee10 resection.

As specifically illustrated in FIGS. 10B and 10C, after the inferior endof the femur 12 a is resected, the cutting block assembly 160 can bemounted thereto. Specifically, the rail 164 is mounted to the femur 12using the mounting posts 180. This allows the rail 164 to besubstantially fixed relative the femur 12 for use of the cutting block162. The cutting assembly 160 is inserted through the incision 30 andmounted to the distal end 12 a of the femur 12. This allows the cuttingblock 162 to translate medially/laterally while mounted on the rail 164,which is mounted or fixed to the femur 12. The cutting block 162, as isgenerally known, allows for resection of the anterior side 12 b andposterior side 12 c of the femur 12. Similarly, the saw blade 100 can beinserted through the cutting block 162 to resect the posterior side 12 cof the femur 12. Therefore, the exemplary illustration resecting theanterior side 12 b of the femur 12 is not meant to limit the followingclaims.

After the cutting assembly 160 is mounted to the femur 12, using propermethods, such as adhesives or screws, the saw 100 can be insertedthrough the incision 30 and through the cutting block 162. This allowsthe saw 100 to be properly aligned relative to the femur 12 using thecutting block 162. Therefore, the saw blade 100 can resect portions ofthe anterior side 12 b of the femur 12. Due to the narrowness of theneck 104 of the saw blade 100, the incision 30 may be small, even thoughthe saw blade 100 must move from side to side to resect portions of thefemur 12. For example, the saw blade 100 illustrated in solid lines,shows the position of the saw blade before it moves to resect a portionof the femur 12. The saw blade 100′, shown in phantom lines, illustratesa portion of the vibrational motion of the saw blade 100 while inoperation. The narrow neck 104, however, does not substantially engagethe edges of the incision 30 during this process. Therefore, the traumato the soft tissue 22 is minimized due to the narrow neck 104.Similarly, the cutting block 162 and cutting assembly 160 as a whole isminimized in size to reduce trauma to the soft tissue 22 during thepositioning and removal of the cutting assembly 160.

After the saw blade 100 has been used to resect a portion, for examplethe lateral side, of the femur 12, which it is able to reach in a firstposition, the cutting block 162 can be translated along the rail 164 toa second position. In this second position, the cutting block 162 may beheld or locked in place with the locking pin 174. Alternatively, nolocking mechanism may be used to allow the cutting block 162 to movefreely depending upon the desires of the user. Nevertheless, the cuttingblock 162 may translate to the medial side of the knee 10, as the knee10 illustrated in FIG. 6 is a right knee, such that the saw blade 100 isable to easily resect the medial side of the femur 12.

The saw blade 100 may be positioned to cut the anterior side 12 b of thefemur on the medial side of the femur 12. In this way, the rail 164needs only be mounted once while the cutting block 162 can be translatedalong the rail 164 to cut all the necessary portions of the anteriorside 12 b of the femur 12. Similarly, the cutting block 162 may beremoved and rotated to cut the posterior side 12 c of the femur 12 withthe saw blade 100. An appropriately configured cutting block 162 allowsthe saw blade 100 to resect both the anterior 12 b and the posterior 12c of the femur 12 without rotating the cutting block 162.

Extending from the cutting block 162 are the soft tissue holders orpushers 166 a and 166 b. The soft tissue pushers 166 a and 166 b arepositioned to ensure that the soft tissue 22 does not intersect theguide bore 168 of the cutting block 162. Moreover, the soft tissuepushers 166 a and 166 b help move the incision 30 relative the femur 12during the procedure. Specifically, the incision 30 is a substantiallysmall incision, such that the instruments may be inserted into the knee10, but not so large as to produce large amounts of trauma to the softtissue 22. Nevertheless, the movement of the cutting block 162 can movethe incision 30 and the surrounding soft tissue 22 relative the femur 12to allow for the cutting block 162 to easily move along the rail 164. Inthis way, the cutting block 162 helps reduce trauma to the soft tissue22 surrounding the knee 10. It will be understood that any appropriatesaw blade may be used in conjunction with the cutting block 162,therefore the cutting assembly 160, it is not necessarily exclusive touse with the narrow saw blade 100.

With reference to FIG. 10C, the femur 12 is illustrated resected suchthat the anterior side 12 b has been resected to form a substantiallyflat and planar portion. In addition the posterior side 12 c of thefemur 12 has also been resected. The saw blade 100 has been insertedthrough the cutting block 162 to resect the posterior side 12 c of thefemur 12. In this way, the rail 164 need only be mounted once to resectboth the anterior side 12 b and the posterior side 12 c of the femur 12.Moreover, the use of the translating cutting block 162 allows the rail164 to be positioned only once to resect both the medial and lateralportions of the femur 12 as well. This allows the rail 164 to be mountedonly once to the femur 12 to resect all portions of the anterior side 12b and the posterior side 12 c. This assists in reducing trauma to thefemur 12 during the resection procedure and can decrease healing timeafter the procedure is completed.

According to various embodiments, as discussed above and herein, aguiding member, for example, a translating or sliding cutting block, canbe used to form various portions or resections of a selected bonyportion. For example, as discussed above, the translating cutting block162 may translate relative to the rail 164 to form a resection of aportion of a bone or other selected anatomical portion. The cuttingblock 162 may assist in guiding a cutting tool even if the cutting blockis not the same size or dimension, in at least one direction, as theresection to be made. Nevertheless, various cutting blocks may be usedin various methods to form resections of various portions of theanatomy.

With reference to FIG. 11, a guide member 200, such as a translating orsliding cutting block, is illustrated. The translating cutting block 200may be used to form any appropriate portion, such as a resection in aselected portion of the anatomy. For example, the cutting block 200 maybe used in forming a distal resection of a the femur 12. Further, itwill be understood that the cutting block 200 may be used with anyappropriate portions to assist in or guide the cutting block 200 forvarious preparations.

Regardless, the cutting block 200 may generally include a firstattachment and/or rail portion 202. The translating cutting block 200may also include a guide or translating portion 204. The guide portion204 may include a slot or cutting guide 206 that may define a cuttingguide surface 208. The guide surface 208 may be any portion defined bythe cutting or translating member 204 to assist in guiding a selectedinstrument, such as the saw blade 100, to form a selected resection.Nevertheless, it will be understood that the translating guide portion204 may be used to guide any appropriate member or instrument relativeto a selected portion of the anatomy to perform a selected procedure.Moreover, the translating or guide member 204 may also include a secondguide slot 210 or any appropriate number of guide slots for variouspurposes or applications.

With reference to FIG. 11, the translating cutting block 200 includesthe translating member 204 that can translate relative to the fixed orrail member 202. As illustrated, the guiding block portion 204 may movefrom a first position to a second position 204′, illustrated in phantom.In this way, the translating cutting block 200 may be positionedrelative to a selected portion of the anatomy to cut a first portion ofthe anatomy or guide a selected instrument relative to a portion of theanatomy, and move to a second position to cut a second portion ofanatomy or guide an instrument relative to a second portion of theanatomy. In this way, the translating block 200 may include a size, suchas that discussed above, that is smaller than a selected working area.For example, the cutting block 200, or any portion thereof such as afirst end 204 a and a second end 204 b of the guide member, may be lessthan about 8 cm, and may include an exemplary length of about 4 cm. Onemay understand that various instruments may be used for minimally, lessinvasive, or conventional open procedures. The reduced size andcharacteristics of various instruments may reduce the recovery timeexperienced by a patient after a procedure. Also the time for theprocedure may be reduced as well as many other effects.

The rail member 202 may define a tenon 202 b of a rail portion. The railmember 202 may also define any other projection, such as a “T” or “D”shape or any appropriately shaped depression. The guide member 204 maydefine a complimentary portion, such as a mortise 204 c, to associatewith the tenon 202 b. The guide member 204 may include or define anyother depression or projection to associate with the rail member 202.Also, as discussed above, various portions may be provided to lock orfix the guide member 204 relative to the rail member 202. Alternatively,or in addition thereto, the guide member 204 may move generally freelyrelative to the rail member 202 in a selected manner.

The rail member 202 may include a bore or a plurality of bores 212 toreceive a selected member, such as a pin or screw to fix the translatingmechanism 200 relative to a portion of the anatomy. It will beunderstood, however, that any appropriate mechanism may be provided toassist in positioning the rail or fixed member 202 relative to aselected portion of the anatomy. For example, a pin or member 236 (FIG.14) may extend from a surface of the fixed member 202 to assist inholding the rail member 202 relative to a selected portion of theanatomy.

Further, the rail member 202 may include a plurality of mechanisms tosubstantially assist in positioning or selectively positioning the railmember 202 in a selected position. For example, a plurality of the bores212 may be provided, each including a different orientation relative tothe rail member 202. Therefore, various mechanisms, such as pins orscrews, may be positioned through a selected plurality of the bores toposition the rail member 202 in a selected position that may bedifferent depending upon the selection of bores 212. Positioning therail member 202 in a different position may allow for movement of theguiding block 204 to various orientations relative to the anatomy.Therefore, it will be understood that the cutting block 200 may bepositioned relative to the anatomy in any appropriate way to assist inguiding a selected mechanism or tool relative to the anatomy.

Further, the translating guiding block 200 may include a central orpositioning bore 214. The positioning bore 214 may be provided throughany appropriate portion of the translating cutting block 200 to assistin associating the translating cutting block 200 or the selectedinstrument. For example, an intramedullary rod or positioning member, asdiscussed herein, may be positioned relative to the anatomy and aportion of the rod may be engaged or associated with the central bore214 to position the cutting block 200 relative to the rod and theanatomy.

With reference to FIGS. 11 and 12, the translating cutting block 200 maybe positioned relative to an intramedullary (IM) rod 220 for use of thetranslating cutting block 200, or at least positioning of thetranslating cutting block 200. The IM rod 220 may be positioned relativeto a paddle or instrument 224 operable to be positioned in the femur 12.It will be understood that the cutting block 200 may be positioned inany appropriate manner and using the IM rod 220 is merely exemplary.

With reference to FIGS. 13-14, an exemplary method of using the cuttingblock 200, such as for a translating distal resection cutting block toresect a distal portion of the femur 12, is illustrated. With referenceto FIG. 13, the paddle instrument 224 may be interconnected with the IMrod 220 and positioned relative to, such as inserted into, a portion ofa bone, such as the intramedullary canal of the femur 12. The paddleinstrument 224 may be selected from one or more paddle instruments basedupon a paddle portion 226. The paddle portion 226 may be selected forvarious purposes, such as selecting a distance from a distal portion 228of the femur 12. The paddle portion 226 may also be selected for variousother purposes, such as selecting a varus and/or valgus angle forformation of the distal cut of the femur. Therefore, it will beunderstood that the paddle portion 226 or the instrument 224 may beselected for various appropriate purposes. For example, a plurality ofthe instruments 224 may each include different paddle portions 226. Thedifferent paddle portions may provide different attributes, such as aselected varus and or valgus angle. The angle may be translated inpositioning the cutting block 200 with the instrument 224, as discussedherein.

Once the intramedullary rod 220 and the paddle instrument 224 arepositioned relative to the femur 12, an attachment mechanism 234 may bepositioned relative to the femur 12 and the paddle instrument 224. Theconnection mechanism 234 may be provided to interconnect, at leasttemporarily, the translating cutting block 200 with the instrument 224for selectively positioning the translating cutting block 200 relativeto the femur 12. It will be understood that the connection portion 234may not be necessary and may be provided to allow for a selectedinterconnection. Nevertheless, the translating cutting block 200 may bepositioned with the paddle instrument 224 without use of the connectioninstrument 234. The translating cutting block 220 may associate or beinterconnected with the paddle instrument 224 without an internal orseparate connection means. Nevertheless, it will be understood that theconnection instruments 234 may be used for various purposes.

Generally, the interconnection mechanism includes a pin 234 a that caninterconnect with the paddle portion 226 of the instrument 224. The pin234 a allows an interconnection between the guide block 200 and thepaddle portion 226. As discussed above this may assist in forming theappropriate angles in the resection. Also, the pins 234 a allow forselectively removing the various portions to assist in the resection orfor other purposes.

The translating cutting block 200 may then be interconnected with theinterconnection portion 234. For example, the connection member centralbore 214, extending from the translating or guide portion 204 of thetranslating cutting block 200, may interconnect with the interconnectionmechanism 234. The interconnection of the translating portion 204 withthe interconnection mechanism 234 may allow for selective positioning ofthe guide surfaces 208 relative to the femur 12 in a selected manner.The interconnection may be any appropriate connection. For example, amagnet or magnets may be provided to interconnect the translatingcutting block 200 for positioning thereof. As discussed above, one ormore of the guide surfaces 208 may be provided and defined by the guidemember 204 for guiding a selected instrument, such as a saw blade.Therefore, positioning the guide member 204 with the interconnectionmechanism 234 may assist in selectively positioning the guide surfaces208 relative to the femur 12 in a selected manner.

Once the guide portion 204 is interconnected with the interconnectionmechanism 234, the rail portion 202 may be interconnected with the femur12 near the distal end 228 in a selected manner. For example, a pin orscrew 236 may be provided to interconnect the rail portion 202 with thefemur 12. The pin 236 may be any appropriate pin, and for example, mayinclude a quick release pin, such as a Quick-Release Drill Bit™,provided by Biomet, Inc. of Warsaw, Ind. Although any appropriatemechanism may be used to hold or fix the rail portion 202 to the femur12, the quick release pins may allow for an easy and efficientconnection of the rail portion 202 with the femur 12 and for anefficient and effective removal therefrom.

It will be understood that the rail member 202 may be connected to thefemur in any appropriate location. Nevertheless, it may be selected toposition the bores of the rail member 202 away from the distal end 228of the femur 12. The bores 212 may also, or alternatively, be positionednear the distal end 228 of the femur 12. Also the distance the bores 212are positioned from the guide member 204 may be selected for variouspurposes.

Once the translating cutting block 200 has been positioned relative tothe femur 212 in a selected manner, the paddle instrument 224 and the IMrod 220 may be removed from the femur 12. The removal of the paddleportion 224, the interconnection portion 234, and the IM rod 220 mayallow for a clear or easier access to the distal portion 228 of thefemur 12. After the IM rod 220 has been removed from the femur 12, aselected instrument may be guided with the translating guide portion204.

With reference to FIG. 14, the translating guide portion 204 may guide aselected instrument, such as a saw 240. The saw 240 may be anyappropriate saw, such as a reciprocating saw powered by a hand tool 242or the saw 100. The saw 240 may pass through the guide slot 206 and beguided along the guide surface 208. In this way, the guide portion 204may be provided to guide the saw 240 relative to the femur 12. This mayallow for a resection of the distal portion 228 of the femur 12 to forma substantially planar or resected surface 244 of the femur 12.

The resected surface 244 of the femur 12 may be any selected size. Forexample, the resected portion 244 of the femur 12 may be substantially awidth or distance between the epicondyles of the femur 12. The distancebetween the epicondyles may be dependent upon the size of the patient,but may generally be about 4 cm to about 13 cm (about 1.5 inches toabout 5 inches). As discussed above, the guide member 204 may include alength between the first end 204 a and the second end 204 b that is lessthan the distance of a selected femur. Therefore, as discussed above,the guide member 204 may move relative to the rail or fixed portion 202.Thus, once the resected surface 244, or a portion thereof, is resectedsuch as the length of the slot 206 defined by the guide member 204, theguide member 204 may be moved relative to the rail portion 202 tocomplete a resection of the femur 12 in a selected manner.

Therefore, the guide member 204 need not include a length, for example alength of the guide surface 208, an entire dimension or size of thesurface to be resected. As discussed above, the guide member 204 is ableto move, such as translate or rotate, relative to the rail member 202.Thus the guide member 204 may allow movement of the guide surface 208.In this way the resection may be completed using the guide member 204and generally not requiring the resected surface, or a part thereof, toguide the tool to form the resection. The guide member 204 may providethe guide surface for the entire resection to be performed.

Moreover, the rail portion 202 may be moved due to the plurality of thebores 212 in the rail member 202. Therefore, for example, if themovement or translation of the guide member 204 is not great enough tocomplete a resection of the femur 12 at a selected manner, the railportion 202 may be moved relative to the pins 236. This may allow forfurther resection to form the resected surface 244. The bores 212 mayalso allow for additional resection to be performed for various reasons.The pins 236 may be positioned in various bores to select an amount ofresection to occur.

Regardless, it will be understood that the guide member 204 need not bean extended or large size, due at least in part to a movement of theguide member 204 relative to a portion of the anatomy, such as the femur12. Regardless, the guide member 204 may be used to guide the entireformation of the resected surface 244 due, at least in part, to themovement of the guide member 204. For example, the resected surface 244or a portion thereof, need not be used to guide the saw 240 relative toanother portion of the anatomy, such as to complete the resected surface244, due at least in part to a movement or a translation of the guidemember 204.

Further, the rail portion, including a depth or dimension 202 a mayallow for positioning of the rail member 202 relative to a selectedportion of the femur 12. For example, the translating block 200 may bepositioned substantially near the distal portion 228 of the femur 12,such as substantially near the condyles. Therefore, the incision formedin the soft tissue relative to the femur 12 may be substantially smallor minimized and still allow passing and positioning of the translatingblock 200. The bores 212 defined in the rail portion 202 allow forfixing the translating member 200 relative to the anatomy, such as thefemur 12, near the distal portion 228 of the femur 12 for variouspurposes, such as reducing the size of the incision.

In addition, as discussed above, various other portions of the anatomymay be resected or prepared, such as a proximal portion of a tibia. Inaddition, as discussed above, various other resections of the femur 12may be formed. Various guide members, such as translating movable guidemembers may be used to form various resections of the femur, such as ananterior and posterior cut, and an anterior and posterior chamfered cut.The various resections of the femur 12 may allow for positioning of adistal femoral implant on the femur 12 through the incision. The distalfemoral implant may articulate with the tibia or articulate with atibial implant according to various embodiments. Nevertheless, it willbe understood that various resections may be formed to allow forreplacement or repair of selected anatomical portions.

Referring to FIG. 15, an exemplary tibial resection apparatus 1100according to the present teachings includes a support block 1102 and acutting guide 1104. The support block 1102 may have a superior surface1106 (FIG. 16A) that defines a groove 1108. The groove 1108 may beoriented medially-laterally and can be curved generally parallel to acurved attachment surface 1110 of the support block 1102. The supportblock 1102 of FIG. 16A is configured for a left leg. It will beunderstood, as illustrated in FIGS. 21A-22, that a support block 1102may also be configured for the right leg. The curved attachment surface1110 is configured to mate with at least a portion of the medial surface14 a of a proximal portion of the tibia 14, as illustrated in FIGS. 21Aand 22.

Referring to FIGS. 16A, 20 and 23, the support block 102 can include acut-out 1130 and an aperture 1132 that can receive a fastener or holdingportion 1136 for attaching an extramedullary rod 1134 of a standardtibial guide 1139. The standard tibial guide 1139 can be attached to thedistal tibia with a yoke or other known attachment device 1162. A set ofholes 1138, including a plurality of pairs of holes 1138, can bearranged in parallel and equidistant pairs, or any appropriate format,on a front surface 1150 of the support block 1102. The holes 1138 areconfigured to selectively receive respective locking pins of a tibialstylus 1200 for setting the depth of resection.

When the stylus 1200 engages the pair of holes 1138 located mostinferiorly from the superior surface 1106, a tip 1202 of the stylus 1200is at the level of the saw guide slot 1112 of the cutting guide 1104.Engaging the stylus 1200 with the next pair of holes 1138, correspondsto an increase of the distance of the tip 1202 by a predetermined amountequal to the spacing between the consecutive pairs of holes 1138, suchas, for example, about 2 mm. Engraved lines or other indicator markings1152 can be provided along each pair of holes 1138 to indicate the levelof the tip 1202 at each location of the stylus 1200, thereby functioningas a stylus scale.

Other holes 1140 through the support block 1102 can be provided forreceiving fasteners, such as a locking pin 1201, such as those discussedabove, that attach the support block 1102 against the tibia 14. Thesupport block 1102 can also include an engagement area 1154 that caninclude a slot or opening for receiving a handle 1160 with openings 1164for supporting other alignment rods, as illustrated in FIG. 24.

The cutting guide 1104 may define a saw blade slot 1112 and includes apeg 1114 extending from an inferior surface 1105 of the cutting guide1104. The peg 1114 is configured to be received in the groove 1108, suchthat the cutting guide 1104 can slide along the groove 1108 relative tothe support block 1102. The groove 1108 and the peg 1114 can includecomplementary engagement or locking features, such as, for example, arim 1116 projecting from the wall of the groove 1108 into the groove1108 and a slot 1118 defined by upper and lower shoulders 1120 of thepeg 1114. When the peg 1114 is engaged with the groove 1108, the cuttingguide 1104 can stably rotate about the peg 1114 relative to the supportblock 1102. This can allow the cutting guide 1104 to be rotated away ortoward the medial surface 14 a of the tibia 14 providing greater freedomof movement to the cutting saw blade. The cutting guide 1104 can have astraight edge, one angled edge, or two angled edges 1122 on the sidefacing the tibia 14. The edges 1122 assist in moving and help provideclearance for movement of the cutting guide 1104 during movement of thecutting guide relative to eh support block 1102 (FIGS. 21A and 21B).

The saw blade slot 1112 has a width W (FIG. 15) that is generallygreater than a corresponding width of the saw blade 240, or otherappropriate saw or cutting tool, to allow a swinging motion of the sawblade relative to the saw blade slot 1112, in addition to the motion ofthe saw blade that is provided by the sliding motion of the cuttingguide 1104 along the groove 1108. Cutting can begin at the medialsurface 14 a of the tibia 14 and proceed posteriorly and laterally,advantageously facilitated by the sliding motion of the cutting guide1104. It will be understood that the resection can begin at anyappropriate location and proceed according to various methods.

The tibial resection apparatus 1100 of FIG. 15 is merely exemplary.Arcuate sliding is allowed between the support block 1102 and thecutting guide 1104 by including a groove-peg engagement device. Althoughexemplary, the groove 1108 is defined in the superior surface of thesupport block 1102 and the peg 1114 extends from the inferior surface1105 of the cutting guide 1104. It will be understood that other slidingengagement devices are contemplated. For example, the groove 1108 can bedefined in the inferior surface 1105 of the cutting guide 1104, and apeg 1114 a can extend from the superior surface 1106 of the supportblock 1102, as illustrated in FIGS. 16B and 17B. The groove and pegarrangement is generally configured to enable relative sliding betweenthe support block 1102 and the cutting guide 102 along an angled and/orarcuate path defined by the groove 1108, whether the groove 108 isdefined on the support block 1102 or the cutting guide 1104. Further,the peg 1114 can be modularly coupled to the support block 1102 or thecutting guide 1104. The peg 1114 can also be a bolt, a pin or ballconfigured for engagement with the groove 1108. The engagement of thepeg 1114 and the groove 1108 may also allow for rotation of the cuttingblock 1104 relative to the support block 1102. Thus the cutting guide1104 may move in any appropriate manner relative to the tibia 14 and thesupport block 1102.

The support block 1102 may be positioned relative to the tibia 14 usingany appropriate mechanism, such as the support rod or extramedullary rod1139 or the handle 1160 (see FIG. 24). The following discussion may bereadily adapted for use with any appropriate support mechanism and theuse of the extramedullary rod 1139 is merely exemplary. Therefore, itwill be understood that the support block 1102 and the associatedcutting guide 1104 may be positioned relative to the tibia 14 in anyappropriate manner.

As discussed above, the extramedullary rod 1139 may be positionedrelative to the tibia 14 using any appropriate mechanism, such as theclamp 1162. Generally a user may affix the clamp 1162 relative to aselected portion of a patient's anatomy, such as near the ankle, to holdthe extramedullary rod 1139 relative thereto. The extramedullary rod1139 may include the holding portion 136 that interconnects with thesupport block 1102. The user may position the extramedullary rod 1134 inany appropriate manner, such as generally aligned with a tibia 14 orpositioned at an angle thereto, depending upon the procedure.Regardless, the fastener 1136 allows for positioning of the supportblock 1102 near the tibia 14 through an incision, such as the incision30, in the soft tissue 22. The incision 30 may be formed in anyappropriate position relative to the tibia 14, such as a medial side ofthe tibia 14. It will be understood, however, that the incision 30 maybe formed in any appropriate manner, depending upon a selected manner ofperforming a procedure relative to the tibia 14. Further, the incision30 may include any appropriate dimension, such as a dimension of about 7cm or more. Nevertheless, the incision 30 may be formed in anyappropriate length according to selected procedures.

Therefore, the incision 30 allows for positioning of the support block1102 relative to the tibia 14 using the extramedullary rod 1134 as aninitial support member. Further, the support member 1102 may include alength 1102′ (see FIG. 16A) allowing it to pass through the incision 30to be positioned relative to the tibia 14. The length of the supportmember 1102′ may be any appropriate length, such as about 1 cm to about10 cm. For example, the length 1102′ may be about 3 cm.

Once the support member 1102 is positioned relative to the tibia 14,such as relative to a medial side 14 a of the tibia 14, the stylus 1200may be used to position the support member 1102 relative to a superioror proximal portion of the tibia 14. As discussed above, the stylus 1200may be used to select a position for the support member 1102 relative tothe superior surface of the tibia 14. Once positioned relative to thetibia 14 with the stylus 1200 the pins or other support members 1201 maybe positioned to the bores 1138 to hold the support member 1102 relativeto the tibia 14. The pins 1201 may allow for holding the support member1102 relative to the tibia 14, when the extramedullary system 1139 isremoved. Therefore, once the stylus 1200 is used to set the position ofthe support member 1102 relative to the tibia 14, the extramedullary rodsystem 1139 may be removed after the pins 1201 are used to hold thesupport member 1102 relative to the tibia 14.

Further, as discussed above, the cutting guide block 1104 may then beinterconnected with the support member 1102 (FIG. 22). The cutting guideblock 1104 may also include any selected length 1104′ to allow it topass through the selected incision 30. For example, the length of themovable cutting guide 1104 may be about 1 cm to about 5 cm, and mayexemplary be about 4 cm. Further, the slot 1112 defined by the movableguide member 1104 may include a length that is less than or equal to thelength the 1104′ of the movable cutting guide 1104. Further, asdiscussed above, the slot 1112 defined by the movable cutting guide 1104may include substantially straight, angled, or beveled edges to assistin guiding the saw blade 240.

The movable cutting guide 1104 that includes the groove 1108 is allowedto interact with the pin 1114 that may extend from a movable cuttingguide 1104. Nevertheless, as discussed above, the support member 1102may define the pin 1114 while the movable guide member 1104 defines thegroove 1108 to allow for the movable guide member 1104 to move relativeto the support member 1102. Further, other appropriate mechanisms may beallowed to movably interconnect the support member 1102 with the movableguide member 1104. Nevertheless, the movable guide member 1104 isgenerally able to move relative to the support member 1102 or the tibia14 in any appropriate manner. Further, as discussed above, the dimensionand orientation of the pin 1114 may allow the movable guide member torotate relative to the support member 1102 or the tibia 14.

It will be understood that the movable guide member 1104 may beinterconnected with any appropriate portion, and not necessarily thesupport member 1102. For example, the movable guide member 1104 may beinterconnected with the tibia or the femur substantially directly.Further, the support member 1102 may be interconnected with the femur12, such that the movable guide member 1104 may generally move relativeto the support member 1102 interconnected with the femur 12. Regardless,the movable guide member 1104 is generally allowed to assist in guidingthe saw blade 240 relative to the tibia 14 to resect a selected portionof the tibia 14.

The movable aspect of the cutting guide 1104 allows the cutting guide1104 to be moved relative to the tibia 14 according to selected manners.For example, the movable cutting guide 1104 may be positioned relativeto the tibia 14 at a generally anterior position relative to the tibia14. This may allow for a first selected cut or resection portion to bemade on the tibia 14 (FIG. 21A). The movable cutting guide 1104 may thenbe moved relative to the tibia 14 or the support member 1102 to a secondposition, such as generally medially, relative to the tibia 14 (FIG.21B). In the second position, the movable guide member 1104 may allowfor easy access to a different aspect of the tibia 14 not easilyaccessed and/or allowed from the first aspect. Therefore, the guidemember 1104 may allow for the saw blade 240 to be substantially guidedduring the entire resection of the tibia 14.

Although it will be understood that the saw blade 240 may be movedrelative the tibia 14 to insure a selected resection of the tibia 14,the movable cutting guide 1104 may allow for the saw blade 240 to beguided with the saw guide 1104 during a substantial portion over theresection of the tibia 14. Therefore, the movable guide member 1104 mayallow for the selected resection to take place in a substantially guidedmanner. The guide member 1104 movements may allow for the formation of avirtual entire guide surface. That is a guide surface that spans thesize of the resection to be performed or allows guiding of the saw 240to make the resection. As discussed above the moveable guide member 1104can be used to guide the saw 240 during the entire resection, eventhough the guide member 1104 may not include a dimension as large as theresection to be performed.

The movement of the movable guide block 1104 may be any appropriatemovement, such as those discussed above. Therefore, the movable guideblock 1104 may generally slide relative to the support member 1102 andalso rotate relative to the support member 1102. Therefore, the movementof the movable guide member 1104 may be used by a user to guide the sawblade 240 in a selected manner. This may assist in reducing thenecessity of a user's perception and free hand guiding of the saw blade240 to perform a selected resection of the tibia 14.

Further, the movement of the movable guide member 1104 relative tosupport member 1102 and the tibia 14 allows for the movable guide member1104 to be smaller than a selected dimension of the tibia 14, such as awidth medial/lateral or a depth anterior/posterior of the tibia 14.Nevertheless, the movement of the guide member 1104 allows the saw blade240 to be guided during a substantial portion of the resection due tothe movement of the movable guide member 1104.

The movable guide member 1104 may be positioned easily through theincision 30. Providing the small or minimally invasive incision 30 mayreduce trauma and a healing time for the patient after the resection ofthe tibia 14. The incision 30 may be formed at a selected length and theincision 30, or the edges thereof, may be moved with the movable guidemember 1104 to form the resection of the tibia 14. Therefore, theincision 30 need not be large enough to expose the entire surface orarea of the tibia 14 and may include a dimension to allow forpositioning of the movable guide member 1104 relative to the tibia 14.

Nevertheless, the movable guide member 1104 may be used to guide the sawblade 240 to form the entire resection of the tibia 14 due to themovement of the movable guide member 1104 and the incision 30 may bemoved with the movable guide member. Therefore, it will be understoodthat various retractors, guides, tissue pushers, and the like may beused when performing a procedure with the movable guide member 1104 andmay be incorporated with the movable guide member 1104. Further, thespace of the incision 30 and the size of the various members, such asthe support member 1102 and the guide member 1104, may allow for reducedtension, movement, and the like of the soft tissue, relative to thetibia 14 and the femur 12. For example, the procedure may be performedrelative to the tibia 14 while substantially eliminating or reducing themovement of the patella or the patellar tendon and substantiallyeliminating or reducing the need to evert or rotate the patella 20.

As discussed above, a cutting guide may rotate relative to variousportions of the anatomy, such as the tibia 14. With reference to FIG.25, a cutting guide 2500 may be positioned relative to the tibia 14,such that it substantially rotates and/or pivots relative to the tibia14. The cutting guide may include any appropriate dimensions, such asone to allow it to be used with the incision 30. The cutting guide 2500may include a longitudinal dimension of less than about 7 cm, and mayexemplary include a dimension of about 4 cm.

The cutting guide 2500 may pivot about a pivot point 2502, such as a pinor member that may extend from an extramedullary rod 1134, or otherappropriate member. For example, the cutting guide 2500 may interconnectwith the support block 1102 so that the cutting guide 2500 may bothrotate and slide relative to the support member 1102. Regardless, thecutting block 2500 may rotate generally in the direction of arrow 2500Arelative to the tibia 14.

The saw blade 240 may pass through the rotating cutting guide 2500through any appropriate portion, such as a slot, guide surface, or thelike defined by the rotating cutting guide 2500. It will be understoodthat the saw blade 240 may be substantially equivalent to a dimension,such as a width of 2500′ of the cutting guide 2500. Therefore, thecutting guide 2500 may be substantially small relative to the tibia 14.For example, the dimension 2500′ may be about 1 cm to about 2 cm.

The rotation of the cutting guide 2500 may allow the saw 240, or aportion thereof, to move over substantially the entire surface of thetibia 14. The cutting guide 2500 may allow this without substantiallytranslating the cutting guide 2500 medially/laterally oranteriorly/posteriorly, relative to the tibia 14, but generally throughrotation alone. The cutting guide 2500 may rotate generally in thedirection of arrow 2500A to allow movement of the saw blade 240 relativeto the tibia 14. Further, the saw blade may move relative to the guide2500, such as generally along the length of the saw blade 240 to resectvarious portions of the tibia 14. Thus, the tibia 14 may be resectedwithout translating the cutting guide 2500 other than rotating thecutting guide 2500 and moving the saw 240. Therefore, the cutting guide2500 may include a substantially small size to allow it to pass easilythrough the incision 30 or other appropriate portions.

The cutting guide 2500 may be positioned relative to the tibia 14 in anyappropriate manner. For example, the cutting guide 2500 may bepositioned relative to the support member 1102 and held in a selectedposition therewith. Therefore, it will be understood that the cuttingguide 2500 may be positioned relative to the tibia 14 in any appropriatemanner, such as those described above. Regardless, the cutting guide2500 may rotate relative to the tibia 14 to allow for guiding the saw240 generally over the entire area to be cut of the tibia 14. Again,this may be useful in reducing the need to view the entire area of thetibia 14 to be resected and ease the performance of a tibial resection.

With reference to FIG. 26, a femoral cutting guide assembly 2600according to various embodiments is illustrated. The cutting guideassembly 2600 generally includes a reference tab or flange 2602 and acutting guide member 2604. The cutting guide member 2604 is generallyable to move relative to the flange 2602 in the direction of arrow 2606.The cutting guide assembly 2600 is generally able to be mounted relativeto the femur 12 to translate generally medially/laterally in thedirection of arrow 2606, relative to the femur 12 (FIG. 28). The cuttingblock 2604 includes one or more guide surfaces or slots 2608. The guideslots 2608 may be used to guide a saw, such that the saw 240, relativeto the femur 12. The resection of the femur 12 may be according to anyappropriate mechanism, such as those described above and herein.

The flange 2602 includes a first rail or bar member 2610 that isoperable to interconnect with a channel 2612 in the guide member 2604.It will be understood that the bar member 2610 may extend from the guidemember 2604, while the track 2612 is defined by the flange 2602.Further, various other mechanisms, such as those described above,include the “T” or dovetail interconnection that allows for movement ofthe guide block 2604 relative to the flange 2602.

The flange 2602 may be fixed relative to any appropriate portion of theanatomy, such as the femur 12. For example, pins or locking members 2614may be used to interconnect the flange 2602 with the femur 12 accordingto any appropriate mechanism. It will be understood that the pins 2614may be passed through any appropriate portion of the flange 2602 tointerconnect the flange 2602 with the femur 12. Further, the pins 2614may be positioned on the flange 2602 in any appropriate location, suchthat the pins 2614 do not interfere with the resection guided with theguide block 2604.

The guide block 2604 may be similar to the guide block 160 discussedabove. The guide block 2604, however, may include a posterior resectionslot 2608 a, an anterior resection slot 2608 b and a chamfer cut slot2608 c. It will be understood that the chamfer cut slot 2608 c may beused to form both anterior and posterior chamfer cuts. The cuts used toresect the femur 12 may be similar to those cuts generally known in theart to prepare a femur for a total knee replacement or replacement ofthe condyle portions of the femur. Therefore, one skilled in the artwill understand that the guide block 2604 may be formed in anyappropriate manner to form selected resection portions of the femur 12.Regardless, the guide block 2604 may move relative to the flange 2602,such that the guide slots 2608 may be moved and effectively span thearea to be resected on the femur 12. Therefore, the guide slots 2608need not be the entire size or dimension of a resection, such as a widthof a resection, but may be moved, such that the saw 240 is guided alongthe guide slot 2608, substantially during the entire resection.

The guide member 2604 may include any appropriate dimension, such as adimension 2604′. The dimension 2604′ may be any appropriate size, suchas above 1 cm to about 8 cm. For example, the dimension 2604′ may beabout 4 cm. The dimension 2604′ may allow for the resection assembly2600 to be positioned relative to the femur 12 through the incision 30that may be a substantially small or minimally invasive incision. Ratherthan providing an incision that allows for complete access to an entireknee portion 10, the incision 30 may be moved with the resection guide2604 as the guide member 2604 moves via the track assembly 2610, 2612relative to the flange 2602.

With further reference to FIG. 27, the resection assembly 2600 may bepositioned through the incision 30 relative to the femur 12. Theincision 30 may be formed in the knee 10 of the patient and theresection guide assembly 2600 positioned relative to the femur 12 in anyappropriate manner. For example, the flange 2602 may be positionedrelative to the femur 12 using any appropriate sizing or positioningmechanism. For example, an IM rod or other appropriate mechanism, suchas those described above or generally known in the art, may be used toassist in positioning the flange 2602 relative to the femur 12.Regardless, the flange 2602 provides a mechanism to allow the guidemember 2604 may move relative to the femur 12.

As illustrated in FIG. 27, the guide member 2604 may be positionedrelative to the femur 12 and the saw 240 passed through a selected slot2608 with the guide member 2604 to perform a resection of the femur 12.The various resections may include those described above or generallyknown in the art for resecting the femur 12. Further, once a portion ofthe resection is performed, the guide member 2604 may be moved mediallyor laterally relative to the femur 12 to perform or continue theresection of the femur 12. In this way, the guide member 2604 may beused to guide the saw 240 during a substantial portion of the resectionof the femur.

As discussed above, the resection assembly 2600 may be used to guide thesaw 240 relative to the femur 12. Because the guide member 2604 may bemoved relative to the femur 12, such as with the flange 2602, the guidemember 2604 can be less than a dimension of the femur. For example, thedimension 2604′ may be less than a medial/lateral distance betweenepicondyles, yet the entire resection of the femur may be guided withthe guide member 2604. As discussed above, the sliding or moving guideblocks may be positioned relative to various portions of the anatomy,such as the femur 12 or the tibia 14, through generally small orminimally invasive incisions. Regardless of the size of the guide block,such as the guide block 2604, or the incision, the guide block 2604, orany appropriate guide block according to various embodiments, may beused to guide a substantially complete resection without including aguide slot or surface the is substantially equivalent to the resecteddimension. Therefore, the guide block 2604 may be positioned relative tothe femur 12 and used to resect the femur 12 without providing the guideblock 2604 to be a substantially large or equivalent to the resectionsize.

Further, the flange 2602 may include any appropriate dimension. Forexample, the flange may include a length or depth dimension 2602′ thatis long enough or great enough to allow positioning a pin 2614, suchthat it may not interfere with the resections or cuts formed with theblock 2604. In positioning the flange 2602 relative to the femur 12positioning of the pins 2614 relative to the cutting block 2604 and thefemur 12 may be taken into account. The flange 2602 may include aplurality of bores 2603 that may allow for passing the pins 2614therethrough, such that they may interconnect the flange 2602 with thefemur 12. Therefore during the procedure, a user may select the positionof the pins 2614 relative to the femur 12 using the flange 2602 toposition the pins 2614. It will be understood that any appropriateholding or locking mechanism may be provided to hold the flange 2602relative to the femur 12 during the resection of the femur 12 and themovement of the guide block 2604 and the pins 2614 are merely exemplary.

With reference to FIG. 28, a moveable cutting guide 2700, according tovarious embodiments is illustrated. The moveable cutting guide 2700includes a guide block 2702 that includes a plurality of guide surfaces2704. The guide surfaces may include an anterior guide slot 2704 a, aposterior guide slot 2704 b, and a chamfer guide slot 2704 c. Asdiscussed above the chamfer guide slot 2704 c may be used to form bothanterior and posterior chamfer cuts. The cutting guide 2700 may includea dimension 2700′ that is any appropriate dimension. The dimension 2700′may be about 2 to about 8 cm, and may exemplary be about 4 cm.

The guide block 2702 may move relative to a rail 2706. The rail may beheld relative to a portion of the anatomy, such as the femur 12, with apin 2708. The rail 2706 may be modularly connected with the cuttingblock 2702, such that the rail 2706 can be first positioned on the femur12 by itself or separately. The cutting block 2702 can then be coupledto the rail 2706, after the rail 2706 is attached to the bone. It willbe understood that the rail 2702 may be pre-assembled with andnon-removably coupled to the cutting block 2702. The rail 2706 may bealso defined by the block 2702 and a member defining a groove affixed toa portion of the anatomy. The block 2702, however, may define a groove2710 to interact with the rail 2706. The groove 2710 and the rail 2706may be designed to cooperate with the chamfer guide slot 2706 c tocreate a clearance therefore. The rail 2706 may also be any appropriatedimension, such as within or of equivalent size to the cutting guide2700.

The moveable guide assembly may be fixed to a distal portion of thefemur, similar to the guide block in FIG. 10B. The rail 2706 may beformed to extend the entire width of the femur 12 or only a portionthereof. As the guide block 2702 defines the guide slots 2704 the rail2706 may be positioned in a single position and the block 2702 moved tomove the guide slots 2704 relative to the femur 12. In this way theresection of the femur 12 may be guided with the block 2702 for asubstantial portion or all of the resection. This can be done eventhough the guide block 2702 or the guide slots 2704 alone are not thedimension, such as a width, of the entire resection to be performed.

Therefore, it will be understood, according to various embodiments, thatthe resection of the femur 12 or the resection of the tibia 14, or anyappropriate resection, may be performed using various instruments. Asdescribed herein and above, the various guide members may move relativeto the portions to be resected, such that the guide member need notinclude a dimension that is substantially equivalent or greater than thearea to be resected. Rather the guide member may move, either translategenerally in a straight line, rotate around a point, move in a curvedpath, or move in any other appropriate dimension, to allow for guidingof a cut member, such as a saw blade, relative to the member to beresected. This allows for generally physically or substantially guidingthe cut member during the entire resection procedure, thereby minimizingthe amount of freehand or unguided resection to be performed.

The guide member is able to move during the resection to be performed.Either the guide member may be moved to a selected position and lockedfor a portion of the resection or may move freely during the resection.Regardless, the guide member, according to various embodiments, is ableto define a virtual or constructive guide surface that is larger thanthe physical dimension of the guide member or guide surface itself. Theconstructive guide surface allows the user to guide an instrument duringan entire resection, however, rather than only a portion thereofregardless of the size of the guide member. The constructive guidesurface may be equal to, smaller than, or larger than a selecteddimension of the resection as well. For example movement of the cuttingguide may define a constructive guide surface smaller than a dimensionof a selected resection, but movement of the guide instrument in theguide area allows for a resection of a selected dimension.

With reference to FIG. 29, a kit 400 includes a plurality of the sawblades 100 and 130 and the translating cutting block assembly 160 and/or200. The kit 400, for example, may include a first narrow cutting saw100 and a second narrow cutting saw 100′. The first narrow cutting saw100 may include a neck 104, which includes a width A₁. The width A₁ canbe any selected width to be used in a resection procedure. The kit 400may also include a second narrow saw 100′, which has a neck 104′, andincludes a second width A₂. The second width A₂ may be greater than thewidth A₁ of the first narrow saw blade 100. Therefore, the physician mayselect the desired narrow saw blade, 100 or 100′, depending upon thespecific procedure to be performed. For example, a larger incision maybe used or necessary that may accept the larger width A₂ of the secondnarrow saw blade 100′. Nevertheless, a selection is left to the userdepending upon the desires or necessity.

Similarly, the kit 400 may include a first angled saw blade 130, thatincludes an angle F₁ of a longitudinal axis of the neck relative to thelongitudinal axis of the tool engaging section. The kit 400 may alsoinclude a second angled saw blade 130′, which includes a second angleF₂. The second angle F₂ may be greater or less than the first angle F₁.Therefore, the plurality of the angled saw blades 130 and 130′, allowsone to be selected depending upon the particular anatomy of the patientor desires of a physician. Moreover, the various angles can more easilyreach various portions of the knee 10 without great effort or trauma tothe soft tissue 22. For example, the first angle saw blade 130 may beused to resect a first portion of the knee 10 while the second angle sawblade 130′ is used to resect a second portion of the knee 10. Therefore,both of the angled saw blades 130 and 130′ can be used to resect thevarious portions of the knee 10. It will be understood that althoughonly two exemplary saw blades for the narrow saw blade 100 and 100′ andthe angled saw blade 130 and 130′ a larger plurality of the various sawblades may be provided in the kit 400.

Also provided in the kit 400 are the cutting block assemblies accordingto various embodiments. The kit 400 may include any or all of the guideassemblies. Thus the kit 400 may be provided to perform any appropriateprocedure The guide assemblies may include the guide assemblies forfemoral resection 160, 200, 2600, 2700 and those for tibial resections1100 and 2500. Although it will be understood that the cutting guidesaccording to various embodiments may be used to resect any appropriateportion. For example, the rotating cutting guide 2500 may be used toresect the femur or any appropriate boney portion. The cutting blockassembly 160 includes the rail 164 and the cutting block 162. Asdescribed above, the cutting block 162 is able to translate on the rail164 to resect the various portions of the anatomy. Also the cuttingblock 200 may be included. Also various sizes or the cutting guides maybe provided in the kit 400. It will be understood, however, that themovement of the cutting guides, according to various embodiments, mayallow for the provision of one cutting block for all or nearlyall-possible patient sizes. The cutting guide assemblies, according tovarious embodiments, can be used in conjunction with the narrow sawblades 100 and 100′ or other generally known saw blades. The cuttingguide assemblies, according to various embodiments, can also be used inconjunction with the angled saw blades 130 and 130′ if desired.Nevertheless, the resection kit 400 can be provided for use in asurgery. Therefore, during the operative procedure, the various sawblades can be selected and used by a physician in conjunction withcutting guide assemblies, according to various embodiments.

Further, the guide members according to various embodiments, such as theguide member 162, 200, 1100, and/or 2500 may be used alone or incombination while performing a selected procedure, such as a total kneearthroplasty. The moveable guide members can be used to form resectionson various bone portions, such as those described above and herein. Thevarious guide members to guide resections of the femur 12 and/or tibia14 may include those described above and herein. Therefore, the variousguides may be used in conjunction, should a surgeon desire to perform asubstantially minimally invasive procedure to form a complete kneearthroplasty, or in a conventional open procedure. For example, the kneearthroplasty may be substantially unicondylar, bicondylar, or a completeknee arthroplasty. Further, a complete femoral component, that is onethat is interconnected and replaces both condyles of the femur, may beused. Exemplary knee implants include the Maxim™ and the Ascent™provided by Biomet, Inc. of Warsaw, Ind. Other femoral implants mayinclude those described in U.S. patent application Ser. No. 10/770,870,filed Feb. 3, 2004, entitled “METHOD AND APPARATUS FOR PROVIDING SOFTTISSUE RETRACTION WHILE STABILIZING A CUTTING INSTRUMENT”, incorporatedherein by reference. Therefore, the various instruments may be used by asurgeon, should the surgeon desire to perform a substantially minimallyor less invasive procedure through an incision, such as the incision 30,relative to the knee of a patient.

Referring to FIGS. 30-35, other related modular instrumentation andsurgical components can be used according to the present teachings toprovide an exemplary surgical kit 3100 illustrated in FIG. 35. Thecomponents can also be combined to provide various assembledinstruments, including exemplary modular sizing devices 3200, 3200′illustrated in FIGS. 30 and 31A, and an exemplary modular cutting device3300 illustrated in FIG. 32. The various components of the kit 3100, aswell as various instruments that can be assembled from the kit 3100,including, for example, the sizing device 3200 or 3200′ and the cuttingdevice 3300, can have streamlined profiles with reduced dimensions toaccommodate the confines of small incisions, should it be desired by thesurgeon, as may be practiced in minimally invasive procedures.

Referring to FIGS. 30, 31 and 31A, each the exemplary sizing devices3200, 3200′ includes modularly connected components, such as,respectively, a sizer base 3202 (or 3202′), a stylus 3204, and a coupler3206 for connecting the sizer base 3202 to the stylus 3204. Each sizingdevice 3200, 3200′ can be used, for example, as an anterior-posteriorsizer for the distal femur in an exemplary knee procedure. The coupler3206 can provide magnetic coupling between the sizer base 3202 (or3202′) and the stylus 3204, and is movable relative to the base 3202 (or3202′). The stylus 3204 can include a handle 3220, a tip 3222, and astylus arm 3224, extending from the handle 3220, to the tip 3222. Aportion of the stylus arm 3224, can be a plate 3226 having planarsurfaces, and can be made from magnet-attracting material, such as, forexample, ferromagnetic material. The coupler 3206 can include a leg 3208and an arm 3210. The leg 3208 can be a cylindrical rod slidably receivedin a bore 3212 of the sizer base 3202. The coupler arm 3210 can be aplate having a planar surface 3214 that can support the plate 3226 ofthe stylus arm 3224. Magnetic coupling can be provided by using amagnetic member or portion 3230. For example, the magnetic member 3230can be a separate magnet that is received in a cavity 3228 of thecoupler 3206. The coupler 3206 can be conveniently made as an integralpiece of substantially L- or T-shape. The coupler 3206 can also bemodular, combining a separate rod that defines the coupler leg 3208, anda separate plate that defines the coupler arm 3210. The arm 3210 caninclude a hole that receives a portion of the leg 3208 and also definesthe cavity 3228 for the magnetic member 3230. The coupler leg 3208 canalso be connected to the coupler arm 3210 with a Morse taper connection.Alternatively, instead of using a separate magnetic member 3230, aportion of the coupler arm 3210 can be magnetic. The magnetic member3230 interacts with magnet-attracting portion 3226 of the stylus arm3224 to connect the stylus 304 to the sizer base 3202.

Each sizer base 3202, 3202′ can include an open slot 3232 and acalibrated scale 3234 adjacent to the slot 3232. The position of anindex or mark 3236 on the leg 3208 of the coupler 3206 relative to thescale 3234 can be used for size measurement when the tip 3222 of thestylus 3204 is in contact with a bone surface. Referring to FIG. 31, thesizer base 3202 can include two extensions 3240 that are configured toreceive posts 3242, such as bolts. The posts 3242 can include a shaft3244 and a head or ball 3248 that can be gripped using a quick-releasepistol-grip handle 3110, such as the one illustrated in FIG. 35. Thequick release handle 3110 includes a spring-loaded trigger 3112 and aball bearing (not shown) inside a barrel 3114 for gripping the head post3242. Referring to FIG. 31A, the sizer base 3202′ can include a footcomponent 3333 having a pair of feet 3332 configured to be receivedunder the posterior condyles. The foot component 3333 can be integral tothe sizer base 3202′ or modularly coupled to the sizer base 3202′, suchas, for example, by an extension/slot coupling. In the illustrativeexample of FIG. 31A, the extension 3331 is attached to the footcomponent 3333, and is received in a slot 3335 of the sizer base 3202′,although the converse (extension 3331 attached to the base 3202′ andslot 3335 defined in the foot component 3333) or other couplingarrangements can be used.

The sizer base 3202′ can also include a rail or drill guide 3320′integrally or modularly coupled thereto. The drill guide 3320′ can befirst attached to the bone with pins, and the sizer base 3202′ can becoupled to the drill guide 3320′ afterwards. The sizer base 3202′ canfurther include an aperture 3260 for engaging a quick-release handle3110′. The quick release handle 3110′ is coupled to a spring loadedplunger 3262 for locking a plunger ball (not shown) with the aperture3260.

Referring to FIGS. 32-34, the exemplary cutting device 3300 can includevarious modularly coupled components, including a cutting block 3310, adrill guide 3320, and an alignment guide 3330. The cutting block 3310defines a cutting slot 3312 for receiving a saw blade or otherappropriate resection tool. The drill guide 3320 can be slidably coupledto the cutting block 3310, using for example, a T-connection, asillustrated in FIG. 32, for sliding in the medial-lateral directionrelative to the bone, such as, for example, the distal femur for anexemplary knee procedure. The T-connection can be defined by a T-shapedboss 3340 and a mating T-shaped slot 3342. The T-shaped slot 3342 can bedefined either on the drill guide 3320, as shown in FIG. 32, or on thecutting block 3310, and the T-shaped boss 3340 can be correspondinglydefined on the mating component. The drill guide 3320 can include one ormore pairs of drill holes 3348, 3350. The drill guide can also includeapertures 3352 for receiving a positioning/carrying handle (not shown).

Referring to FIG. 34, the exemplary alignment guide 3330 can include apair of feet 3332 configured to be received under the posterior condylesof the femur for alignment therewith, a flange 3334 and a post 3336. Theflange 3334 is configured to be received into the cutting slot 3312 ofthe cutting block 3310 for positioning, alignment and drillingprocedures. The feet 3332 can be configured with neutral or three 3°(left or right) angle, as illustrated in FIG. 35. The alignment guide3330 is removed before cutting, leaving the cutting slot 3312 availableto receive a cutting blade for an optional posterior cut.

It will be appreciated that although the exemplary sizing device 3200and cutting device 3300 can be used together in one procedure, each canalso be used as an independently-used device. Additionally, the sizingdevice 3200 can be used without the cutting device 3300, or inconjunction with a second, stand-alone drill guide 3420 and a second,stand-alone alignment guide 3430 having feet 3432, both illustrated inFIG. 35. The stand-alone drill guide 3420 includes a slot 3421 that canengage with a peg 3431 of the stand-alone alignment guide 3430. A post3436 extends from the peg 3431 and is adapted to engage with the barrel3114 of the pistol-grip handle 3110 for quick release.

With continued reference to FIG. 35, the alignment guide 3330 can beprovided in different sizes and configurations for the left and rightknees, having, for example, feet that are neutral or at about 3° angle.Similarly, the second alignment guide 3430 can be provided in differentsizes and configurations for the left and right knee, and can also beused in unicondylar mode. Accordingly, the instrumentation of the kit3100, provides the surgeon with an assortment of components from whichto pick and choose for assembling an appropriate instrument for sizing,aligning or cutting in connection with knee or other surgicalprocedures. The modularity of the instrumentation and the compact sizeof the various components coupled with the provided ergonomic and quickrelease handles 3110 can be advantageous use for minimally invasiveprocedures or in conventional open procedures.

Referring to FIG. 36, in an exemplary knee procedure, the sizing device3200 can be placed flush with the distal femur 12, which has beenexposed through a small incision 502. Using the handle 3220 of thestylus 3204, the tip 3222 is moved along the anterior femoral surface todetermine the appropriate size. Drill holes can be prepared using thealignment guide 3430 with the feet 3432 under one or both condyles ofthe distal femur and attaching the drill guide 3420 to the secondalignment guide 3430 as described above for quick release.

The cutting device 3300 can be used as illustrated in FIG. 32. Thecutting block 3310 with the drill guide 3320 assembled thereon can bepositioned flush against the distal femur 12. The flange 3334 of thealignment guide 3330 can be inserted into the cutting slot 3312 and thefeet 3332 can be positioned under the femoral condyles. The drill guide3320 can be slid in the medial-lateral direction, as needed, for placingthe drill holes 3348, 3350 in appropriate position, approximately nearthe center of the distal femur 12, for inserting drill pins into thebone. The alignment guide 3330 can then be removed, and femoralresection can be performed using a resection blade through the cuttingslot 3312. The cutting block 3310 can be slid relative to the drillguide 3320 during the cutting operation to expand the sweep of the saw.

Referring to FIG. 37, an exemplary soft tissue retractor 4000 accordingto the present teachings can be coupled with a surgical instrument 4002,such as, for example, a cutting guide having a cutting slot 4004. Theretractor 4000 can be permanently, removably or modularly coupled to theinstrument 4002 with fasteners or other coupling devices 4008 known inthe art, such that the retractor 4000 can move between deployed andstorage positions. The retractor 4000 can include an attachment portion4020 rotatably coupling the retractor 4000 to the instrument 4002, andat least one elongated or finger-like portion 4022 for pushing softtissue 22 away from the cutting slot 4004. The retractor 4000 can bespring biased by a spring or other biaser 4010 in the deployed(extended) position for pushing away soft tissue 22. A retainer 4006,such as, for example, a hook, a lever or other retaining device, can beattached to the instrument 4002 to retain the retractor 4000 in thestorage position. It will be appreciated that additional retractors 4000may be added, as desired, for particular instruments 4002 or surgicalprocedures.

The retractor 4000 can be built-in at the time of manufacture of theinstrument 4002 or can be retrofitted to the instrument 4002 at a laterdate. With the retractor 4000 attached to the instrument 4002 andavailable for deployment as needed, the possibility of trauma to softtissue 22 can be reduced. Coupling the retractor 4000 to the instrument4002 provides a compact design that can be used in procedures involvingsmall incisions, as well as other procedures. The compact design canreduce the number of separate instruments in the wound area, possiblyreducing the possibility of mishaps or the necessity for additionalassistants providing retractors to the surgeon or operating suchinstruments to keep soft tissue 22 from the wound site.

The resection of the femur 12, or any appropriate bone, can be performedusing a resection guide according to various embodiments. It will beunderstood that any appropriate resection guide may be used and may beselected for various purposes, such as the patient's anatomy,preferences of a user, patient requirements, or any appropriate purpose.Nevertheless, as discussed above, the various embodiments of a resectionguide can include various features such as moveable portions, fixedportions, holding portions, or the like. It will be understood, that theresection guide, according to any appropriate embodiment, can be used.

For example, with reference to FIGS. 38-40, a resection guide 4500 isillustrated. The resection guide or apparatus can be used to resect anyappropriate portion of the anatomy, such as the femur 12. As discussedfurther herein, the resection guide 4500 can be used to resect a femurin any appropriate manner, such as in a reduced invasiveness procedure,a minimal incision, or for any appropriate procedure. As discussedherein, the resection guide 4500 can be used to resect the femur 12through any appropriate incision that can be formed in the anatomy, suchas that discussed herein.

The resection guide 4500 can include any appropriate portions. Theresecting guide can include a main body or resection section 4502, afirst moveable or sliding guide section 4504 and a second sliding ormoving resection section 4506. The moveable sections or moveableportions can also be referred to as a dynamic portion. The portions canbe provided fixed or moveable relative to one another.

The first moving guide section 4504 can be used to cut a selectedportion of the anatomy, such as an anterior portion of the femur toallow for implantation of a selected implant or prosthesis such as adistal femoral prosthesis. The first guide section 4504 can define acutting slot 4508 by a first wall 4510, a second wall 4512, a third wall4514, and a fourth wall 4516. Each of the walls, 4510-4516 can be formedof any appropriate material defining the cutting slot 4508. Further, thewalls can be configured relative to one another in any appropriatemanner. For example, the walls 4510-4516 can be welded together in anyappropriate manner, such as a polygon, a rectangle, or the like.Further, the moving guide slot 4504 can include or be formed of asubstantially single member in which the slot 4508 is machined orformed, rather than being formed by four separate wall members4510-4516. Extending from the slot-defining member 4509 of the firstguide portion 4504 is a stem or peg 4518. The stem 4518 can interconnectwith a rail member 4520. The rail member 4520 can move or be fittedwithin a track or slot 4522 defined by the main body 4502. As discussedabove, the rail member 4520 can be formed in any appropriate shape, suchas a T-shape, a dovetail, a polygon, or the like. Further, it will beunderstood that the first guide member 4504 can substantially define atrack member or portion while the main body 4502 defines a rail portionto interact therewith. Nevertheless, the interaction of the rail member4520 and the track portion 4522 allows for the first guide portion of4504 to move relative to the main body 4502.

The second guide portion 4506 can also define a guide body 4530 whichdefines a guide slot 4532 that is defined by a first wall 4534, a secondwall 4536, a third wall 4538, and a fourth wall 4540. As discussedabove, the various walls, 4534-4540 can be interconnected in a selectedmanner to define the guide slot 4532, that can be rectangular, or anyappropriate shape. Further, the guide body 4530 can be formed of asingle member from which the guide slot 4532 is defined such as withmachining, cutting or the like. Further, a stem or peg 4542 extends fromthe guide body 4530 and interconnects with a second rail portion 4546.The rail portion 4546 can ride in a second track portion 4550 defined bythe main body 4502. Similar to the first guide portion 4504, the body4502 can define a second rail portion while the second guide portion4506 defines a track portion. Nevertheless, the interconnection allowsthe second guide portion 4506 to move relative to the main body 4502.Further, as discussed herein, the second guide portion 4506 can beformed or positioned to resect any appropriate portion such as aposterior portion of a femur for reception of a selected implant orprosthesis, such as a distal femoral prosthesis.

The main body portion 4502, in addition to defining the two trackportions 4522, 4550 also can define guide slots. For example, a firstguide slot or guide portion 4560 can include the first guide surface orportion 4562, which can be on the front of the guide member 4502 and asecond or back guide surface 4564. When positioned on a selected portionof the anatomy, such as the femur 12, the first guide portion 4560 canbe used to form an anterior chamfer cut on the femur 12. Similarly, asecond guide portion 4566 can define a first guide surface 4570 on afront portion of the guide body 4502 and a second guide surface 4572 ona back portion of the main guide portion 4502. The second guide surface4566 can be used to form any appropriate resection, such as a posteriorchamfer cut on a portion of the anatomy, such as the femur 12.

The main guide portion or body portion 4502 can define a longitudinalaxis 4580. The longitudinal axis 4580 can generally define a longestportion or longest dimension of the main body portion 4502, the mainbody portion 4502 can define a dimension 4582 of any appropriatedimension. Generally, the dimension of 4582 can be selected to be about75% of a maximum width of a distal femoral prosthesis to be positionedon a femur 12 on which the resection guide 4500 is used. It will beunderstood that the dimension 4582 can be about 2 cm to about 35 cm, andcan be about 3 cm to about 10 cm.

The main body portion 4502 can also define, near the respective trackportions 4522 and 4550 tapered or angle portions, such as a first angledportion 4584. The angled portion 4584 can define an angle 4586 relativeto the longitudinal axis 4580. The angle 4586 can be any appropriateangle such as about 1° to about 89°. For example, the angle can be about10° to about 60° to achieve a selected geometry of the main body portion4502. The angle 4586 can be a selected angle to provide a minimumdimension 4590 defined by the main body portion 4502. It will beunderstood, therefore, that the main body portion 4502 can define angledportions 4584 on several portions of the main body. For example, asecond angle portion 4592 can be defined on a side opposite from thefirst angled portion 4584. The second angled portion 4592 can alsodefine an angle 4594 that is the same or complementary to the firstangle 4586. It will also be understood that other angled portions, suchas a third angled portion 4596 and a fourth angled portion 4598 can alsobe defined by the main body 4502. It will also be understood that theangled portions 4584, 4592, 4596, and 4598 can extend from substantiallystraight edges 4600 and 4602. The straight edges 4600, 4602 can extendbetween relative angled portions and be substantially perpendicular tothe longitudinal axis 4580. The various dimensions of the main bodyportion 4502 can also include a dimension 4610. The dimension 4610 canbe any appropriate dimension such as generally a dimension equivalent toa posterior to anterior dimension of a distal femoral implant to bepositioned relative to the femur 12. Further, the dimension 4590 can beany appropriate dimension such as about 2 cm to about 10 cm. Asdiscussed herein, various dimensions can be selected for dimension 4590and can be selected based on patient requirements, user selection, orany appropriate reason.

As discussed above, the various portions, such as the first guide member4504 and the second guide member 4506 can move relative to the mainguide body 4502 and the track portions 4522 and 4550. The main body 4502can define the stop portion 4620 and 4622 to assist in limiting amovement of the guide portions 4504, 4506 relative to the main body4502. The stop portions 4620 and 4622 can be formed at any appropriateposition on the main body portion 4502 to achieve a selected translationof the guide portions 4504, 4506 relative to the main body 4502.

The guide member 4500 can be formed of any appropriate material for aselected purpose, such as guiding a saw blade 4630 relative to aselected portion of the anatomy. For example, the resection guide 4500can be formed of a metal, a metal alloy, a polymer, or any appropriatematerial. Nevertheless, the various portions of the resection apparatus4500 can be formed of different materials for different purposes.

With additional reference to FIG. 41, the bone resection apparatus 4500can be interconnected with a femur 12 in a selected manner. For example,a single post 4680 and/or a second post 4682 can be provided to extendfrom the rear of the main body 4502 to extend into the femur 12. Forexample, the two posts 4680, 4682 can be positioned in pre-formed holesor drill holes that have been provided in the femur 12 for variouspurposes, such as those generally understood in the art. It will beunderstood that the two posts 4680, 4682 can be provided alone or incombination with other connection apparatuses to be fixed into the femur12. For example, the main body portion 4502 can define a first flange4684 that can define a first bore 4686 and a second flange 4688 thatdefines a second bore 4690. The bores 4686, 4690 can be provided toreceive a first pin 4692 and a second pin 4694. The pins 4692, 4694 canassist to further interconnect the resection apparatus 4500 with thefemur 12. It will be understood that the interconnection can be providedin any appropriate manner, and both the posts 4680, 4682 and the pins4692 and 4694 are merely exemplary. It will be understood that oneskilled in the art can provide more than one fixation portion on theapparatus 4500 or it can be provided with any appropriate combination.Further, it will be understood that various additional portions can beprovided to interconnect the resection apparatus 4500 with the femur 12.

Nevertheless, the interconnection of the resection apparatus 4500 withthe femur 12 can allow for resection of various portions of the femur 12for various purposes, such as connecting a prosthesis with the distalportion of the femur 12. As discussed above, the first guide portion4504 and the second guide portion 4506 can move relative to the mainbody portion 4502 in a selected manner. For example, the first guideportion 4504 can move in the direction of arrow 4700 relative to themain body 4502. Further, the second resection or guide portion 4506 canmove in the direction of arrow 4702 relative to the main body 4502.Generally, the direction arrows 4700 and 4702 can define movement eithermedial or lateral relative to the femur 12. Therefore, a saw blade orother cutting instrument that is positioned within the guide slots 4508and 4532, respectively, can be used to resect an entire anterior orposterior portion of the femur 12 without moving the main body portionof 4502 and without providing the guide bodies 4504 and 4506 to span anentire dimension of the femur 12, such as a medial-lateral dimension.Further, the guide bodies 4504, 4506 can include a selected dimension,such as a longitudinal dimension 4710 and 4712. The dimensions 4710 and4712 can be the same or different, depending upon a selected reason. Forexample, it may be selected to provide the first guide portion 4504 witha larger dimension 4712 than the dimension 4710 if the anteriorresection is generally larger than the posterior resection.Nevertheless, the dimensions 4710, 4712 can be provided in a selecteddimension such that it does not span the entire dimension of the femur12, such as an epicondyle width, yet the saw blade can be maintainedwithin the respective guide slots 4508 and 4532 to form an entire orsubstantially entire resection of the femur 12. It will be understood,however, that the resection of the femur 12 can also be substantiallyperformed with a saw blade within the respective guide slots 4508 and4532 while a minor completion of the cut is formed substantiallyfreehand.

Nevertheless, the guide assembly 4500 can be provided to resect aselected portion of the femur 12 to substantially resect the entireportion of the femur 12 with the saw within a respective guide slot.Either the saw can be maintained within the guide slot 4508 and 4532 ofthe moveable guide portions 4504 and 4506, or the saw blade can bemaintained within the guide surfaces 4566 and 4560 of the main bodyportion 4502.

As illustrated in FIG. 41, the resection apparatus 4500 can beinterconnected with the selected bone, such as a distal end of thefemur. It will be understood that various other resections or resectedsurfaces can be formed on the femur 12 in a selected manner, such asusing a distal resection guide, a mill, a drill, or the like. Forexample, the fixation pins 4680 can be inserted into pre-drilled orpre-formed holes formed in the femur 12. The pins 4680 can be sized toengage the bone 12 in a selected manner to hold the main body 4502 in aselected position.

Once the main body 4502 is fixed relative to the femur 12, a resectioncan be formed on the femur 12. For example, the dynamic guide resectionportions 4504 and 4506 can be used to guide a resection of the selectedportions of the femur 12. It will be understood that either of thedynamic resection guide portions 4504, 4506 or only a single one may beprovided or used during a selected procedure. Further, the main body4502 can be provided to act as a member to allow movement of the dynamicguide resection portions 4504, 4506 relative to the femur 12 and not actto define any guide surfaces in and of itself. Therefore, it will beunderstood that the guide surfaces 4560 and 4566 are exemplaryillustrated and are not required on the main body 4502.

Once the resections on the portion of the femur 12 are formed using theresection guide 4500, and any other preparation has occurred, a distalfemoral implant, including those illustrated below in FIG. 42, can beimplanted relative to the femur 12. It will be understood that the femur12 can be prepared in any appropriate manner, such as furtherresections, a mill, a drill and connections mechanisms such bone cement,(e.g., polymethylmethacrylate) can be used. Therefore the resectionapparatus 4500 can be used to resect a selected portion of the anatomy,including the femur 12, to assist in preparing the selected portion ofthe anatomy for implantation of a selected prosthesis. Nevertheless, thevarious portions of the resection apparatus 4500, such as either or bothof the dynamic resection portions 4504, 4506 can be moved relative toanother portion of the resection apparatus 4500 to achieve a selectedresult or to guide a selected instrument during a resection procedure.

As discussed above, the various dimensions of the guide apparatus 4500can be used to provide a selected incision 4720 in a soft tissue 4722surrounding the femur 12. The incision 4720 can be any appropriatedimension, such as a length of about 4 cm to about 15 cm. The dimensionof the guide apparatus 4500 can be provided to achieve a selectedresection of the femur 12 within the incision size. It will beunderstood that various incision sizes may be dependent upon the anatomyof the patient, such as male or female, or dimension of the femur 12,the amount of soft tissue surrounding the femur 12, and otherappropriate considerations. Therefore, it will be understood that thevarious dimensions of the guide apparatus may be chosen or formed toachieve a selected result pre-operatively, intra-operatively, or thelike.

The guide apparatus 4500 can be formed, including the angled portionsand other appropriate dimensions to achieve a selected result. Forexample, as illustrated in FIG. 41, the guide apparatus 4500 can beprovided to be fit within the incision 4720 without substantiallylengthening the incision beyond a selected length. Therefore, theincision can be moved relative to the guide apparatus 4500 to providefor guiding the saw blade to achieve a selected cut while substantiallymaintaining the saw blade within the guide slot, and providing for asmaller incision. As one skilled in the art will understand, theincision can be more easily stretched or pulled near a center point ofthe incision while not at its ends, therefore, the guide apparatus 4500can be provided to fit within the selected incision length.

Further, the guide apparatus 4500 can be provided as a plurality ofguide apparatuses in a kit 4800, illustrated in FIG. 42. For example,the kit 4800 can include three of the guide apparatuses 4500 a, 4500 band 4500 c, and each of the various apparatuses can have differentdimensions, such as the dimension 4582 being 4582 a, 4582 b, 4582 c, orthe like. The dimensions 4582 a-c, can be selected to be different amongthe various of the guide apparatuses 4500 a-4500 c. Each of thedifferent dimensions 4582 a-c can vary depending upon a distal femoralprosthesis 4802, 4804, and 4806. The different distal femoral prosthesescan include different dimensions that can vary depending upon a patient,an anatomy, a gender, or the like. It will be understood, however, thatthe distal femoral prostheses can generally include a differentdimension based upon an anatomy of the patient or the like, but can begenerally included in the kit 4800 for selection by a user during aprocedure. This can allow for intra-operative customization or othervarious purposes when performing a procedure. Nevertheless, theplurality of the cutting blocks 4500 a-4500 c can also be provided toallow for a substantially unique resection of the femur 12 based uponthe selected prosthesis to be positioned relative to the femur 12.Therefore a user, such as a surgeon, can select the appropriateprosthesis, the appropriate resection tool, and perform a selectedprocedure. It will be understood that the customization can be dependentupon a user's expertise, but a plurality can be provided for a selectedcustomization of use.

The description is merely exemplary in nature and, thus, variations thatdo not depart from the gist of the description are intended to be withinthe scope of the following claims. Such variations are not to beregarded as a departure from the spirit and scope of the followingclaims.

What is claimed is:
 1. A system for performing a resection of a selectedportion of an anatomy with a resection instrument, the systemcomprising: a first member fixable to the selected portion of theanatomy; a first movement defining portion defined by the first member;a second member configured to cooperate with the first member; and asecond movement defining portion of the second member; wherein the firstmovement defining portion and the second movement defining portion areoperable to allow the second member to be moveable relative to the firstmember from a first position to a second position; and wherein theresection instrument is positionable relative to the second member inthe first position and in the second position to form a selectedresection of the selected portion of the anatomy.
 2. The system of claim1, wherein the first member includes a support block and the firstmovement defining portion includes a groove configured to slidably androtatably receive the second movement defining portion.
 3. The system ofclaim 2, wherein the second movement defining portion is a peg.
 4. Thesystem of claim 2, wherein the groove is curved.
 5. The system of claim1, wherein the second member is a cutting guide defining a guide slotconfigured to receive the resection instrument therein.
 6. The system ofclaim 1, further comprising a fixation member that extends from thefirst member and is operable to fix the first member relative to theselected portion of the anatomy.
 7. The system of claim 1, wherein thefirst movement defining portion and the second movement defining portionare operable to allow the second member to be slidably and rotatablymoveable relative to the first member.
 8. The system of claim 1, furthercomprising a stylus including a tip at a distal end thereof, the firstmember includes a plurality of coupling members configured to cooperatewith the stylus to secure the stylus to the first member and positionthe tip proximate to the selected portion of the anatomy.
 9. A systemfor resecting a proximal tibial portion with a resection instrument, thesystem comprising: a main guide portion; a first dynamic connectionportion included with the main guide portion; a dynamic guide member; aguide surface defined by the dynamic guide member and configured toguide the resection instrument during resection of the proximal tibialportion; and a second dynamic connection portion included with thedynamic guide member, the first and the second dynamic connectionportions are configured to cooperate with one another to guide movementof the dynamic guide member and the guide surface.
 10. The system ofclaim 9, wherein the second dynamic connection portion is complementaryto the first dynamic connection portion to allow movement of the dynamicguide member relative to the main guide portion.
 11. The system of claim9, wherein the guide surface defined by the dynamic guide memberincludes a fully contained passage.
 12. The system of claim 9, whereinthe first dynamic connection portion is a curved groove defined in themain guide portion.
 13. The system of claim 9, wherein the seconddynamic connection portion is a peg.
 14. The system of claim 9, whereinthe first and the second dynamic connection portions are configured suchthat cooperation therebetween slidably and rotatably guides movement ofthe dynamic member and the guide surface.
 15. A method for resecting aproximal portion of a tibia comprising: fixing a main guide portionincluding a first dynamic connection portion to the tibia; coupling adynamic guide member to the main guide portion through cooperationbetween the first dynamic connection portion and a second dynamicconnection portion of the dynamic guide member; guiding a resectioninstrument to the tibia with a guide surface of the dynamic guidemember; and sliding and rotating the dynamic guide member to guide theresection instrument to various portions of the tibia.
 16. The method ofclaim 15, further comprising positioning the main guide portion at thetibia with an extramedullarly rod.
 17. The method of claim 16, furthercomprising clamping the extramedullarly rod at a distal portion of thetibia.
 18. The method of claim 15, further comprising positioning themain guide portion at the tibia with a stylus removably coupled to themain guide portion.
 19. The method of claim 15, wherein sliding androtating the dynamic guide member includes sliding and rotating thesecond dynamic connection portion relative to the first dynamicconnection portion.
 20. The method of claim 15, wherein sliding androtating the dynamic guide member includes sliding and rotating a peg ofthe second dynamic connection portion relative to a curved slot definedin the first dynamic connection portion.